Series Overview
This module covers the intersection of hematologic malignancy and nephrology -- from AL amyloidosis and light chain deposition disease to the evolving concept of monoclonal gammopathy of renal significance (MGRS). The content integrates comprehensive disease reviews with real clinical cases that demonstrate the diagnostic reasoning, free light chain interpretation, cardiac staging, and treatment decision-making required for these complex patients.
Content
Key Themes Across This Module
- The FLC ratio as diagnostic anchor in CKD: Renal-adjusted reference intervals (iStopMM) eliminate false positives from CKD-related FLC elevation while preserving sensitivity for clonal disease
- Proteinuria phenotyping: Albumin-dominant (glomerular) proteinuria distinguishes AL amyloidosis and LCDD from cast nephropathy -- a single dipstick observation that changes the entire diagnostic trajectory
- Cardiac staging drives prognosis: Mayo cardiac staging (not tumor burden, not renal function) is the dominant prognostic variable in AL amyloidosis
- EF is misleading in infiltrative cardiomyopathy: A "normal" EF can mask cardiogenic shock in amyloid hearts -- cardiac output measurement is essential when clinical severity exceeds echocardiographic appearance
- Tissue diagnosis is non-negotiable: Congo red stain (positive = AL, negative = LCDD) and mass spectrometry amyloid typing are required; clinical suspicion alone is insufficient for treatment decisions
- Dara-VCd transforms outcomes: The ANDROMEDA trial established D-VCd as standard of care with 53% hematologic CR rate, but treatment intensity must be calibrated to organ function, not clone size
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© Urine Nephrology Now | Clinical Mastery Series
Andrew Bland, MD, MBA, MS