From Diagnosis to Dialysis: Managing Primary Membranous Nephropathy in a Patient Living With Human Immunodeficiency Virus (HIV).

Membranous nephropathy (MN) is a significant cause of nephrotic syndrome in adults, with both primary and secondary etiologies contributing to its pathogenesis. This case report explores the clinical course of a 69-year-old African American man with human immunodeficiency virus (HIV) who developed primary MN, progressing to end-stage renal disease (ESRD) despite treatment efforts. Initially diagnosed with IgA nephropathy and HIV-associated immune complex kidney disease (HIVICK), the patient later developed anti-phospholipase A2 receptor (anti-PLA2R) antibody-positive MN. Despite immunosuppressive therapy and partial remission with rituximab, non-adherence to treatment led to disease exacerbation and eventual hospitalization for acute heart failure and worsening renal function. A subsequent renal biopsy revealed severe interstitial fibrosis and tubular atrophy, limiting further therapeutic options. This case underscores the challenges in managing MN, particularly in high-risk patients with comorbidities such as HIV, and highlights the importance of adherence to treatment and tailored management strategies to optimize outcomes in this complex condition.

Cardioembolic Stroke Three Days Post-Video-Assisted Thoracoscopic AtriClip in a Patient With Paroxysmal Atrial Fibrillation.

Atrial fibrillation is a global epidemic due to aging and chronic diseases. Treatment options are expanding to prevent thromboembolism in anticoagulant-ineligible patients. The left atrial appendage, implicated in 90% of embolic strokes, is increasingly managed with occlusion devices like the AtriClip. A 62-year-old woman with prior stroke, severe gastrointestinal bleeding on anticoagulation, and paroxysmal atrial fibrillation experienced sudden left-sided weakness and altered mental status three days post-AtriClip procedure. Brain MRI revealed acute infarcts in the right cerebellum and scattered punctate infarcts in both cerebral hemispheres. No further invasive investigations or interventions were recommended, as they would not influence management. Left-sided weakness improved, and the patient was discharged to a subacute rehabilitation center. Despite the AtriClip's ability to lower stroke incidence by occluding the left atrial appendage, there remains a residual risk of cerebrovascular events that can significantly impact morbidity and mortality. This case underscores persistent risks despite complete appendage closure, emphasizing the need for broader studies on post-AtriClip stroke risk.