Crystalglobulin-associated nephropathy presenting as MGRS in a case of monoclonal B-cell lymphocytosis: a case report.

BACKGROUND: Crystalglobulin-associated nephropathy (CAN), a rare subtype of monoclonal gammopathy, usually associated with multiple myeloma and occasionally monoclonal gammopathy of uncertain significance (MGUS), is characterized by occluding monoclonal pseudothrombi within renal glomerular capillaries and/or interstitial arterioles. Ultrastructurally, these pseudothrombi are unique for having a crystalline substructure. We describe a case of an adult patient with monoclonal B-cell lymphocytosis (MBL) and acute renal failure whose kidney biopsy revealed a rare diagnosis of CAN. CASE PRESENTATION: A 63-year old male presented with a 2-month history of edema, arthralgia and malaise. He had acute kidney injury with hematoproteinuria on urine analysis. Serum and urine protein electrophoresis were both negative. A renal biopsy however revealed features of CAN. Organomegaly, bone pain and lymphadenopathy were absent. A repeat serum electrophoresis was positive for IgA kappa and a free light chain assay showed elevated free kappa light chains. Flow cytometry done subsequently revealed a diagnosis of MBL, chronic lymphocytic leukemia (CLL) type. CONCLUSION: CAN in association with MBL/CLL has not been previously described in literature, and our case highlights yet another instance of monoclonal gammopathy of renal significance (MGRS) where a small B-cell clone resulted in extensive renal pathology without systemic manifestations.

Use of Preventive Cardiovascular Health Care Among Asian American Individuals: A National Health Interview Survey Study.

The risk of atherosclerotic cardiovascular disease (ASCVD) varies across Asian Americans. Heterogeneity in preventive health care use may have a role in health disparity across Asian American populations. We included 318,069 White, Chinese, Asian Indian, Filipino, and 'other Asian' (Japanese, Korean, and Vietnamese) participants with and without a self-reported history of ASCVD or ASCVD risk factors (including hypertension, hypercholesterolemia, and diabetes) from 2006 to 2018 National Health Interview Survey (NHIS). We used multivariable logistic regression models adjusted for age, sex, US birth, education, insurance coverage, and a comorbidity score to assess the association between Asian American race/ethnicity and annual health care use. Adjusted odds ratios (aOR) with 95% confidence intervals were reported. Of the total, 187,093 participants did not report ASCVD or ASCVD risk factors (mean age, 40.2±0.1 years; 52% women), and 130,976 participants reported ASCVD or ASCVD risk factors (mean age, 58.3±0.9 years; 49.5% women). Compared with White individuals, among the group without ASCVD or ASCVD risk factors (N=187,093), 'other Asian' adults were less likely to visit a general practitioner (aOR=0.80, 0.72-0.89), or check blood pressure (aOR=0.77, 0.66-0.89), blood cholesterol (aOR=0.80, 0.70-0.92), and fasting blood sugar (aOR=0.73, 0.63-0.84). Among participants with ASCVD or ASCVD risk factors (N=130,976), Asian Indian adults were more likely to visit a general practitioner (aOR=1.29, 1.01-1.66), or check blood pressure (aOR=1.27, 0.83-1.96), blood cholesterol (aOR=1.46, 1.00-2.15), and fasting blood sugar (aOR=1.49, 1.11-1.99). Annual preventive health care use is heterogeneous across the Asian American populations.

State-Level Social Vulnerability Index and Healthcare Access: The Behavioral Risk Factor Surveillance System Survey.

INTRODUCTION: Access to health care is affected by social determinants of health. The social vulnerability index encompasses multiple social determinants of health simultaneously and may therefore be associated with healthcare access. METHODS: Cross-sectional data were used from the 2016‒2019 Behavioral Risk Factor Surveillance System, a nationally representative U.S. telephone-based survey of adults aged ≥18 years. State-level social vulnerability index was derived using county-level social vulnerability index estimates from the Centers for Disease Control and Prevention Agency for Toxic Substances and Disease Registry. Analyses were performed in October 2021. Social vulnerability index was ranked according to percentiles, which were divided into tertiles: Tertile 1 (0.10-0.32), Tertile 2 (0.33-0.53), and Tertile 3 (0.54-0.90). RESULTS: In multivariable-adjusted models comparing U.S. states in Tertile 3 with those in Tertile 1 of social vulnerability index, there was a higher prevalence of absence of healthcare coverage (OR=1.39 [95% CI=1.22, 1.58]), absence of primary care provider (OR=1.34 [95% CI=1.22, 1.48]), >1-year duration since last routine checkup (OR=1.18 [95% CI=1.10, 1.27]), inability to see a doctor because of cost (OR=1.38 [95% CI=1.23, 1.54]), and the composite variable of any difficulty in accessing healthcare (OR=1.15 [95% CI=1.08, 1.22]). CONCLUSIONS: State-level social vulnerability is associated with several measures related to healthcare access. These results can help to identify targeted interventions to improve access to health care in U.S. states with high social vulnerability index burden.