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The Diagnostic Trap of Monoclonal Gammopathy of Renal Significance (MGRS): A Kidney First Approach
I have often seen patients with chronic kidney disease who have an abnormal serum protein electrophoresis (SPEP) or free light chain (FLC) ratio and are referred to hematology before a nephrology evaluation. Many undergo an extensive hematologic workup, including a bone marrow biopsy, before their kidney disease is assessed. If the biopsy is negative for multiple myeloma or other hematologic malignancy, the abnormal monoclonal studies are attributed to monoclonal gammopathy o
Viresh Mohanlal, MD
Jan 195 min read
Interpreting Hypocitraturia: An Etiology First Approach
As a nephrologist, I frequently see patients with kidney stones, and one finding that appears with striking regularity on metabolic evaluations is hypocitraturia, defined as urine citrate <320 mg/day. In large-scale urine studies, hypocitraturia is now the third most common metabolic abnormality in stone formers, surpassed only by high urine calcium (>250mg/day) and low urine volume (< 2 L/day), significant risk factors for kidney stone formation (1). Over the past two decade
Viresh Mohanlal, MD
Nov 11, 20254 min read
Rethinking Osteoporosis in Chronic Kidney Disease: Breaking Norms, Saving Bones (Part 1)
Chronic Kidney Disease—Mineral Bone Disease (CKD-MBD) encompasses a spectrum of skeletal, vascular, and mineral metabolism abnormalities,...
Viresh Mohanlal, MD
May 18, 20255 min read
Hyponatremia Due to Reset Osmostat: Uncovering the Clues
Hyponatremia, a condition affecting 1 in 3 hospitalized adult patients, is a prevalent and significant electrolyte abnormality (1). It is...
Viresh Mohanlal, MD
Apr 24, 20254 min read
Non-Proteinuric Diabetic Kidney Disease: The Flip Side of the Story
More than a decade ago, as a new nephrologist in town, I approached diabetic kidney disease (DKD) with the assumption that proteinuria,...
Viresh Mohanlal, MD
Jan 4, 20256 min read
High Output Heart Failure Due to Arteriovenous Access in Hemodialysis Patients: Overflowing and Overlooked
Fluid overload is a common problem in patients on maintenance hemodialysis and is frequently associated with increased hospitalizations...
Viresh Mohanlal, MD
Sep 29, 20244 min read
Non Diabetic Nodular Glomerulosclerosis: Identifying the Culprits
Nodular glomerulosclerosis is a histopathologic finding on kidney biopsy characterized by nodule formation due to the accumulation of...
Viresh Mohanlal, MD
Aug 23, 20244 min read
Target Antigens in Membranous Nephropathy: An Ever Growing Portfolio
Membranous nephropathy(MN) is a renal limited autoimmune glomerular disorder and is the most common cause of nondiabetic nephrotic...
Viresh Mohanlal, MD
Jul 17, 20244 min read
Familial Hypocalciuric Hypercalcemia vs Primary Hyperparathyroidism: Deciphering the Differences
Primary hyperparathyroidism (PHPT) is a relatively common disorder affecting 85 per 100,000 men, with three times higher prevalence in...
Viresh Mohanlal, MD
Jun 21, 20243 min read
Pseudo Acute Kidney Injury: Navigating through False Alarms
Under normal circumstances, serum creatinine values are determined by its metabolic generation from the muscle, renal excretion, and, to...
Viresh Mohanlal, MD
Jun 10, 20245 min read
Idiopathic Hypercalcemia: Looking Beyond the Obvious
Primary hyperparathyroidism (PHPT) is the most common cause of parathyroid mediated hypercalcemia (high normal or high PTH) while...
Viresh Mohanlal, MD
May 31, 20243 min read
Renal Cell Carcinoma: A Great Masquerader
Kidney and renal pelvis cancer is the twelfth leading cause of cancer death in the United States (1). Renal cell carcinoma (RCC) accounts...
Viresh Mohanlal, MD
May 1, 20244 min read
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