AMY DA site - i can identify - Video 2


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