AMY DA site - i can identify - Video 2

Chapters

• 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.