Replacement therapy of hypothyroidism with T4 plus T3 does not improve mood and cognitive performance compared to the standard T4 monotherapy. There is even a higher risk of signs of subclinical hyperthyroidism associated with impaired well-being of the patients, which is clearly caused by significant fluctuations in the steady-state fT3 serum concentrations.

Background Dialysis patients are frequently exposed to Staphylococcus aureus due to stays in dialysis centers, hospitals or rest homes. The hemodialysis vascular access is a potential entry site for S. aureus , in particular when using a central venous catheter (CVC) which increases the risk of sepsis compared to arteriovenous (AV) fistula. We prospectively followed a cohort of 86 hemodialysis patients from an outpatient dialysis center over 25 months analyzing S. aureus carrier status, S. aureus infection rates and mortality. Methods Demographic data and patients´ medical histories were collected and followed from all hemodialysis patients. Blood samples, nasal swabs and swabs from the hemodialysis vascular access site were taken every six months for a period of 25 months and tested for S. aureus . Strains were cultured and further characterized by spa PCR and microarray-based genotyping. Resulting data were compared with those from the general population. Results In cross-sectional analyses, an average of 40% of hemodialysis patients were S. aureus carriers compared to 27% in the general population. Longitudinally, a total of 65% were S. aureus carriers: 16% were persistent carriers, 43% were intermittently colonized. The most common S. aureus lineage in the dialysis patient cohort was the clonal complex (CC) 8 and the spa type t008, while in the general population, the clonal complex CC30 dominates. During the study period, we observed six S. aureus -associated blood stream infections with one S. aureus attributable death. S. aureus carriers with an AV fistula were more densely colonized in the nasal mucosa compared to patients with a CVC. Overall mortality was lower for hemodialysis patients with a positive S. aureus carrier status compared to non-carriers (hazard ratio of 0.19). Conclusions Compared to the general population, hemodialysis patients were more frequently colonized with S. aureus and displayed both different S. aureus colonization densities as well as lineages, possibly explained by more frequent exposure to health care environments. The lower overall mortality in carriers compared to non-carriers is intriguing and will be investigated in detail in the future. Trial registration ISRCTN 14385893 , 2. October 2018, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12882-019-1332-z) contains supplementary material, which is available to authorize...

The prevalence, number, and mean size of renal cysts are higher in men compared to women and are associated with age. In addition, renal cyst prevalence is higher in hypertensive and smoking subjects.

ZusammenfassungDie Sonografie ist das wichtigste bildgebende Verfahren in der nephrologischen Primärdiagnostik. Sie ist jederzeit verfügbar, die Patienten müssen kaum auf die Untersuchung vorbereitet werden und im Gegensatz zu vielen anderen Untersuchungsmethoden hat die Sonografie keine schädlichen Nebenwirkungen für den Patienten und die untersuchten Organe. Die Sonografie der Nieren zeigt Organgröße und Beschaffenheit der Nierenrinde (= Nierenparenchym) und gibt Aufschluss über akute und chronische Krankheiten. Es können bestimmte Erkrankungen ausgeschlossen werden (z. B. Harnstau) und Hinweise auf andere Erkrankungen gesehen werden (z. B. Raumforderungen, Zysten, narbige Einziehungen, Verschmälerungen oder Schwellungen des Nierenparenchyms). Die Sonografie der Armgefäße vor Shuntanlage, die Beurteilung des ausgereiften Shunts (Flussvolumen, Stenosen) und auch die ultraschallgestützte Beurteilung der Füllung der Vena cava bei Dialysepatienten sind weitere wichtige Anwendungen des Verfahrens. Die Sonografie wird zudem für Interventionen eingesetzt. Sie wird leitliniengerecht bei Punktionen der Nieren oder der Anlage von zentralvenösen Kathetern verwendet. So hilft die Sonografie bei der Abklärung akuter und chronischer Krankheitsverläufe, der Therapiesteuerung (Bestimmung des Volumenhaushaltes) und ist unverzichtbar zur Risikoreduktion bei Interventionen.

Given the increasing prevalence of chronic kidney disease (CKD) and its impact on health care, it is important to better understand the multiple factors influencing health-related quality of life (HRQOL), particularly since they have been shown to affect CKD outcomes. Determinants of HRQOL as measured by the validated Kidney Disease Quality of Life questionnaire (KDQOL) and the Patient Health Questionnaire depression screener (PHQ-9) were assessed in a routine CKD patient sample, the Greifswald Approach to Individualized Medicine (GANI_MED) renal cohort (N = 160), including a wide range of self-reported data, sociodemographic and laboratory measures. Compared to the general population, CKD patients had lower HRQOL indices. Dialysis was associated with (1) low levels of physical functioning, (2) increased impairments by symptoms and problems, and (3) more effects and burden of kidney disease. HRQOL is seriously affected in CKD patients. However, impairments were found irrespective of eGFR decline and albuminuria. Rather, the comorbid conditions of depression and diabetes predicted a lower HRQOL (physical component score). Further studies should address whether recognizing and treating depression may not only improve HRQOL but also promote survival and lower hospitalization rates of CKD patients.