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AMY DA site - i can identify - Video 2
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00:00:15
The advice for the nephrologist to diagnose AL amyloidosis
00:00:19
earlier is severe nephrotic syndrome or massive proteinuria,
00:00:27
again, in the absence of diabetes, hypertension, rheumatologic conditions,
00:00:34
specifically if nephrotic syndrome is associated with massive albuminuria
00:00:40
of greater than 5 grams, greater than 10 grams.
00:00:44
Patients also have other organ system involvement with congestive heart failure,
00:00:49
autonomic neuropathy leading to postural hypotension, or low blood pressures.
00:00:55
Again, this constellation of these syndromes and these clinical features
00:00:59
should lead a nephrologist to suspect a systemic disease
00:01:05
and maybe a renal biopsy should be performed sooner
00:01:09
rather than later to diagnose AL amyloidosis.
00:01:14
Furthermore, 10% of patients with renal AL amyloidosis may not have
00:01:20
nephrotic syndrome, may not have albuminuria, or albumin spillage in the urine.
00:01:26
They could present just with worsening of renal function.
00:01:30
And in those cases, as well, renal biopsy would make the diagnosis
00:01:35
of AL amyloidosis with amyloid deposits
00:01:38
in the tubulointerstitial region rather than the glomeruli.
00:01:48
A lot, you know, cardiologists and nephrologists,
00:01:50
along with hematologists and neurologists
00:01:52
work very closely together, especially at the
00:01:56
Boston University Amyloidosis Center,
00:01:58
because the key to diagnosing AL cardiac amyloidosis is
00:02:03
is to recognize that these organs are being involved simultaneously.
00:02:07
First of all, realize that this is somebody who has worsening heart failure
00:02:11
with thick heart walls, who also has protein in their urine,
00:02:15
and all at once the differential shifts from
00:02:19
run-of-the-mill heart failure to something that is more,
00:02:23
that is rarer, like a systemic AL amyloidosis.
00:02:27
And so that happens all the time, and it involves a collaboration
00:02:30
between the nephrologist, the kidney specialist,
00:02:33
and the heart specialist to put their heads together and realize that
00:02:36
systemic AL amyloidosis is the common theme here.