About

Dr. Maryam Gondal is an Assistant Professor of Medicine in Nephrology at Yale School of Medicine. She is a graduate of Aga Khan University in Karachi, Pakistan, and completed her Internal Medicine Residency at Indiana University. She subsequently completed her nephrology fellowship training at Yale University in 2017. Dr. Gondal has expertise in treating a wide variety of kidney-related ailments, including glomerulonephritis, genetic kidney disease, hypertension, kidney stones, and diabetic kidney disease. She has a special interest in end-stage renal disease and managing geriatric patients with kidney issues. Additionally, she is involved in the PKD Center of Excellence at Yale and serves as a Sub-Investigator for clinical trials related to Autosomal Dominant Polycystic Kidney Disease (ADPKD). She is the medical director for outpatient hemodialysis and home modalities in downtown New Haven, CT. Her interests also include renal physiology and medical education.

Research topics

• Medicine
• Internal medicine
• Gastroenterology
• Oncology
• Intensive care medicine
• Pathology
• Surgery

Selected publications

• A Rare Manifestation of Myeloma in a Kidney

  Journal of the American Society of Nephrology · 2024-10-01

  articleSenior author

  Introduction: Proteinuria and renal insufficiency are among the most common renal manifestations of Multiple Myeloma [MM] with cast nephropathy being the most common pathophysiology. There have been few case reports of plasma cell infiltration into the kidney resulting in renal dysfunction and proteinuria. Here we describe a case of nephrotic syndrome without deranged creatinine in a patient with long standing MM. Case Description: 64-year-old female with history of anal cancer status post chemoradiation and Ig G multiple myeloma, diagnosed in 2016 refractory to numerous lines of treatment, including CAR-T and stem cell boost, currently on Blenrep and Pomalyst was found to have new onset nephrotic range proteinuria. Urine protein to creatinine ratio 3.74 mg/mg and urine albumin to creatinine ratio 16.1 mg/mg. Serum albumin 1 g/dl, creatinine 1.07 mg/dl [Baseline 0.8-1] and hemoglobin 8.2. Serum protein electrophoresis showed discrete abnormal band measuring 1.7g/dl in the gamma region and serum free kappa/lambda ration >665 unchanged from prior. Renal biopsy revealed diffuse and expansile plasma rich interstitial infiltration distorting the kidney architecture suggestive of infiltrative myeloma in the kidney. Unfortunately, due to the refractory nature and overall decline in her health she was made hospice. Discussion: Renal involvement in multiple myeloma varies widely and there is a wide spectrum of pathologies noted on biopsy. Plasma cell infiltration of the kidney is a rare presentation of MM that showed itself as only proteinuria and no renal function impairment. It is, however, one that is usually associated with advanced myeloma and like in other reported cases, our patient succumbed to complications of advanced myeloma. With this case we emphasize the point that despite marked histologic changes one may not have significant renal dysfunction. It is important to note and recognize this advanced presentation that may otherwise disguise itself as a benign kidney involvement of MM.

  PublisherDOI

• Minimal Change Disease (MCD) and Human Chorionic Gonadotropin (hCG)-Mediated Thyrotoxicosis during Pregnancy

  Journal of the American Society of Nephrology · 2024-10-01

  articleSenior author

  Introduction: Thyroid hormones influence cardiac output and RAAS activity with effects in GFR. Proteinuria has been associated with hypothyroidism but rarely with hyperthyroidism or Graves’ disease in non-pregnant adults. This is a case of AKI with severe proteinuria due to MCD in a woman presenting with hyperemesis gravidarum and gestational thyrotoxicosis. Case Description: A 19-year-old woman at 14 weeks of gestation presented with 4 weeks of hyperemesis accompanied by myalgias, fainting, and muscle weakness. Patient was normotensive, with dry skin and without peripheral edema. Labs showed AKI with creatinine (Cr) of 3.09mg/dL from a normal baseline, BUN of 123mg/dL, hypokalemia, hypophosphatemia, elevated CK of 663 U/L, transaminitis with direct bilirubinemia of 2.4 mg/dL and hypoalbuminemia of 3.0g/dL. TSH was undetectably at <0.005uIU/mL low with elevated free T4 at 4.07ng/dL and normal T3, antithyroid antibodies were negative. Diagnosis of HCG-mediated thyrotoxicosis was made. Urine studies showed total protein-to-Cr ratio of 10.3mg/mg and an albumin-to-Cr ratio of 5.7mg/mg. Kidney biopsy showed diffuse and severe acute tubular injury with myoglobin cast nephropathy. Electron microscopy showed global effacement of foot processes, vacuolization and microvillus transformation of podocytes and the absence of immune deposits. Patient received intravenous fluids, electrolyte replacement and symptomatic treatment of thyrotoxicosis with Propranolol. Emesis improved and she was able to tolerate an oral diet. At 17 weeks of gestation, creatinine had returned to baseline with mild proteinuria and no albuminuria. TSH and free T4 normalized. Discussion: MCD is rare in pregnancy, the etiology is unclear and management includes initiation of immunosuppression. High HCG levels during the first trimester of pregnancy can trigger thyrotoxicosis given structural homology with TSH and hyperemesis. In this case, we observed normalization of albuminuria and thyroid hormone levels as HCG levels dropped with pregnancy progression. We hypothesize that hyperfiltration from pregnancy and increased cardiac output due to increased thyroid activity could have played a role in proteinuria leading to podocyte effacement. Whether immune or inflammatory mechanisms are involved in the interaction between thyroid and kidney disease during pregnancy is unknown.

  PublisherDOI

• Membranoproliferative Glomerulopathy with Masked Monoclonal Deposit: A Case Report

  Journal of the American Society of Nephrology · 2024-10-01

  articleSenior author

  Introduction: Membranoproliferative glomerulonephritis [MPGN] is diagnosed on immunofluorescence. Some cases are influenced by the dysregulation of the alternative complement pathway. Larsen et al. have described the unmasking of immunoglobulin deposits when tissue is treated with paraffin and hence exposing immunoglobulin previously staining negative on immunofluorescence. Here, we describe a case of monoclonal gammopathy of renal significance presenting as MPGN with masked monoclonal deposit. Case Description: 42-year-old male with history of intravenous drug use on methadone who presented with elevated creatinine and lower extremity swelling. No prior history of kidney disease or family history of kidney disease. Labs notable for creatinine 1.81, hemoglobin 7.9 [83.7] and albumin 3. Urine analysis showed +3 protein, RBC and WBC. Spot urine protein/creatinine ration showed 10 mg/mg with >4,400 mg/g albumin to creatinine ratio. Hepatitis B, C, Cryoglobulin, C3 and HIV were unremarkable. Serum kappa/lambda light chain ratio 1.91 and immunofixation positive for Monoclonal component detected in the gamma region in serum and characterized as IgM lambda. Renal biopsy revealed MPGN with masked monoclonal deposit with subsequent bone marrow aspirate showing findings are of a moderately hypocellular marrow with 10% lambda monoclonal plasma cells consistent with involvement by a plasmocytic neoplasm. CYBORD (Cyclophosphamide + Bortezomib + Dexamethasone) and lisinopril was started with improvement in protein/creatinine ratio to 3.42 mg/mg in 1 month and recent creatinine improvement to 1.2. Discussion: This case is unique as it signifies the importance of Monoclonal gammopathy of Renal Significance. Early detection with renal biopsy and initiation of treatment was instrumental in preserving renal function

  PublisherDOI

• Overview of, and Preparations for, Dialysis

  Medical Clinics of North America · 2023-04-14 · 8 citations

  review1st authorCorresponding
  PublisherDOI

• Beyond Loss of Kidney Function: Patient Care in Autosomal Dominant Polycystic Kidney Disease

  Kidney360 · 2023 · 14 citations

  • Medicine
  • Intensive care medicine
  • Internal medicine

  Patients with autosomal dominant polycystic kidney disease benefit from specialized care over their lifetimes, starting with diagnosis of the condition with ongoing discussion of both the renal course and extra-renal issues. Both renal and extra-renal issues may continue to cause major morbidity even after successful kidney transplant or initiation of RRT, and extra-renal disease aspects should always be considered as part of routine management. In this review, we will focus on updates in pain/depression screening, cardiac manifestations, liver and pancreatic cysts, kidney stone management, and genetic counseling. In some instances, we have shared our current clinical practice rather than an evidence-based guideline. We anticipate more standardization of care after the release of the Kidney Disease Improving Global Outcomes guidelines for management in autosomal dominant polycystic kidney disease later this year.

  PublisherDOI

• Thrombospondin Type 1 Domain-Containing 7A (THSD7A)-Associated Membranous Nephropathy Leading to Metastatic Neuroendocrine Carcinoma

  Cureus · 2023-02-21 · 3 citations

  articleOpen accessSenior author

  Idiopathic membranous nephropathy also known as primary membranous nephropathy (PMN) is a common cause of nephrotic syndrome often seen in nondiabetic adults worldwide, rising as high as 40% in adults over the age of 60. Most PMN is mediated by antibodies to the M-type phospholipase A2 receptor (anti-PLA2R) in nearly 70%-80% of individuals. Thrombospondin type 1 domain-containing 7A (THSD7A) accounts for 1%-5% of individuals with PMN. In these individuals, malignancies have a varying incidence of 6%-25%. We present a case of idiopathic membranous nephropathy with anti-PLA2R negative and THSD7A positive with an underlying metastatic neuroendocrine carcinoma. Our goal is to highlight the importance of cancer screening in individuals with THSD7A-positive PMN. In addition, although nonspecific, a negative anion gap may be an indicator of an underlying malignancy.

  PublisherOA PDFDOI

• Hypertension-Induced Thrombotic Microangiopathy Leading to End-Stage Renal Disease

  Cureus · 2023-01-17 · 5 citations

  articleOpen accessSenior author

  Thrombotic microangiopathy (TMA) is a term used for a group of rare and life-threatening hematological conditions. Usually, these disease processes are characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and microthrombi leading to tissue or organ injury. We present a case of a 41-year-old male with TMA induced by uncontrolled hypertension leading to end-stage renal disease requiring hemodialysis. Our goal is to highlight the importance of distinguishing hypertension-induced thrombotic microangiopathy from other etiologies of TMA, particularly thrombotic thrombocytopenic purpura (TTP), and its effect on renal function despite treatment focused on blood pressure control. Thus, it is a challenging diagnosis for clinicians to determine whether to initiate plasmapheresis for prompt treatment of suspected TTP in the setting of severe hypertension with thrombocytopenia.

  PublisherOA PDFDOI

• Granulicatella adiacens Subacute Bacterial Endocarditis Presenting as Diffuse Alveolar Hemorrhage and Infection-Related Glomerulonephritis

  Case Reports in Infectious Diseases · 2022 · 4 citations

  Senior authorCorresponding
  • Medicine
  • Surgery
  • Internal medicine

  , a nutritionally variant streptococcus. The patient later developed acute respiratory failure from diffuse alveolar hemorrhage (DAH). Subacute infective endocarditis can result in serious morbidity and mortality due to its insidious symptoms and subsequent fatal complications.

  PublisherOA PDFDOI

• Immunotherapy-Induced Acute Tubulointerstitial Nephritis

  Cureus · 2021 · 5 citations

  Senior authorCorresponding
  • Medicine
  • Internal medicine
  • Gastroenterology

  Due to its minimal side-effect profile, immunotherapy has become a popular choice for the treatment of advanced melanoma as compared to conventional chemotherapy. The most common side effects associated with immunotherapy include gastrointestinal, pulmonary, and dermatologic manifestations. However, there have been very few documented occurrences of nephrotoxic side effects. We present a case of a 73-year-old male with a past medical history of chronic kidney disease (CKD) stage 3A, metastatic uveal melanoma, and gastroesophageal reflux disease on pantoprazole who arrived at the intensive care unit with altered mental status and creatinine of 27 gm/dl (baseline creatinine of 3 gm/dl about one year prior), after receiving his first dose of ipilimumab and nivolumab approximately 21 days prior. Kidney biopsy demonstrated acute tubulointerstitial nephritis (ATIN). This case highlights the importance of recognizing acute tubulointerstitial nephritis as a side effect of immunotherapy for prompt diagnosis and early treatment.

  PublisherOA PDFDOI

• Do Patients With Primary Biliary Cirrhosis Get Treated for Their Hyperlipidemia?

  The American Journal of Gastroenterology · 2014-10-01

  article1st authorCorresponding

  Introduction: Patients with primary biliary cirrhosis (PBC) often have hyperlipidemia due to ongoing cholestatic liver injury resulting in deranged cholesterol metabolism. Available data suggest that PBC patients may not be at risk of atherosclerosis. However, marked hyperlipidemia can raise concern for atherosclerosis-related complications, and health care providers may be tempted to offer therapy with anti-hyperlipidemic agents. The aim of the current study was to examine the use of anti-hyperlipidemic agents and incidence of complications related to atherosclerosis in a cohort of PBC patients. Methods: PBC patients (N=147) followed at Indiana University Hepatology Clinic were identified, and variables such as patient demographics, liver biochemistries, lipid profile, ursodiol dosage, and study specific clinical outcomes were extracted from review of medical records. Descriptive statistical analysis were performed. Results: The mean age of the study cohort was 55 ± 11 years with BMI of 30 ± 7 kg/m2 (91% female and 68% white). Liver biochemistries showed abnormalities in serum alkaline phosphatase (AlkP) (292 ± 199 U/L), ALT (78 ± 92 U/L), and total bilirubin (1.1 ± 1.4 mg/dL) at baseline. The mean dosage of ursodiol was 14 ± 3 mg/kg per day. Conventional risk factors for complications related to atherosclerosis such as hypertension (34%), cigarette smoking (32%), diabetes mellitus type 2 (14%), and family history of coronary artery disease (28%) or stroke (10%) were recorded in majority of the patients (≥ 94%) at the baseline visit. Lipid parameters were documented in 33% of the cohort with patients receiving treatment with statins (20%), fish oil supplementation (18%), and fibrates (2%). The median duration of follow-up was 1,673 days (IQR: 793-2566 days). During follow-up, normalization of AlkP was 40% and 50% at 1 and 2 years, respectively. Lipid parameters (total cholesterol, LDL-cholesterol, non-HDL cholesterol) were not statistically significantly different during study follow-up (Table 1). No adverse events related to atherosclerosis (myocardial infarction or stroke) were observed during the study period (105,866 person-years).Table 1Conclusion: Anti-hyperlipidemic agents were used infrequently (20% or less) in our study cohort, and no complications related to atherosclerosis were observed during the study period.

  PublisherDOI

Frequent coauthors

• Raj Vuppalanchi

  6 shared

• Marwan Ghabril

  Indiana University – Purdue University Indianapolis

  6 shared

• Craig Lammert

  Indiana University – Purdue University Indianapolis

  4 shared

• Paul Y. Kwo

  2 shared

• Angel Juarez

  Hamilton Medical Center

  2 shared

• Saurabh Agrawal

  Indira Gandhi National Tribal University

  2 shared

• Saieda Alleyne

  2 shared

• Kevin Dao

  Mercer University

  2 shared

Awards & honors

• American College of Gastroenterology - Annual Scientific Mee…
• CMS Five-Star Designation (2020)