Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is included in the group of dysproteinaemias causing renal disease. Only a minority of cases are associated with a haematological malignancy. Two cases have been linked to acute parvovirus B19 infections. We report a 36-year-old African-American woman who presented with renal dysfunction, proteinuria, haematuria and a kidney biopsy reported as PGNMID with IgG3-kappa deposits. Her evaluation for a haematological malignancy was unrevealing. Her parvovirus IgM and IgG levels were positive. The patient was initially treated with an ACE inhibitor and spontaneously remitted with minimal proteinuria after 1 month. Repeat parvovirus B19 serologies 6 months later showed persistent IgG and DNA by PCR positivity but IgM negativity. Given the clinical scenario, we believe that her PGNMID was induced by acute parvovirus B19 infection, which appeared to resolve once her acute infection abated. In this report, we describe our latest understanding of PGNMID.
Introduction:
Recent studies have shown an improvement in survival among Cardiopulmonary resuscitation (CPR) cases in several situations. However, risk factors of CPR among patients admitted for Acute Ischemic Stroke (AIS) remain uncertain.
Methods:
Our analysis used the most extensive US inpatient database, the 2019 National Inpatient Sample, to identify patients diagnosed with CPR among adults of ages 40 and more admitted with a principal diagnosis of AIS. We also queried the different cardiac arrhythmias seen in these patients. Multivariable analysis was used to find the adjusted odds ratio(aOR) of requiring cardiopulmonary resuscitation.
Results:
Our study found 1425 AIS patients requiring cardiopulmonary resuscitation, which was also more common in patients of ages 40-60 (aOR 1.168), diabetics (aOR 1.160), with heart failure (aOR 1.130), hypotension (aOR 1.932), hepatic failure (aOR 3.317), renal failure (aOR 1.856), respiratory failure (aOR 18.223), gastrointestinal hemorrhage (aOR 1.960), hyperkalemia (aOR 2.258), and hypokalemia (aOR 1.265). Smokers (aOR 0.663), Females (aOR 0.878), and those with hyperlipidemia (aOR 0.689) were less likely to need CPR. Several cardiac arrhythmias were noted among those who needed CPR, such as supraventricular tachycardia (6.0% vs. 1.4%), and ventricular tachycardia (19.6% vs. 1.6%), paroxysmal atrial fibrillation (11.9% vs. 9.7%), and ventricular fibrillation (13.3% vs. 0.1%). Finally, CPR patients were slightly younger (mean age 69.82 vs. 70.89) with a longer (mean length of stay 11.48 vs. 5.01 days) hospitalization. A higher mortality rate was also found as 1030 patients died (72.3% vs. 3.6%).
Conclusions:
We observed several significant potential risk factors for CPR among AIS patients. Further studies, strategies, and changes in protocols among AIS admissions may benefit the long-term prognosis.
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