Immunoglobulin Total Light Chains, Urine
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Immunoglobulin light chains are usually cleared from blood through the renal glomeruli and reabsorbed in the proximal tubules so that urine light-chain concentrations are very low or undetectable. The production of large amounts of monoclonal light chains, however, can overwhelm this reabsorption mechanism. The detection of monoclonal light chains in the urine (Bence Jones proteinuria) has been used as a diagnostic marker for multiple myeloma since the report by Dr. H. Bence Jones in 1847.
Current laboratory procedures employ protein electrophoresis and immunofixation for the identification and characterization of urine monoclonal light chains, and the monoclonal light chains may be present in large enough amounts to also be quantitated as an M-spike on protein electrophoresis. The electrophoretic M-spike is the recommended method of monitoring monoclonal gammopathies such as multiple myeloma. Monitoring the urine M-spike is especially useful in patients with light-chain multiple myeloma in whom the serum M-spike is very small or absent, but the urine M-spike is large.
Just as quantitative serum immunoglobulins by immunonephelometry are a complement to M-spike quantitation by serum electrophoresis, this quantitative urine light-chain assay may be used to complement urine M-spike quantitation by electrophoresis.
Monitoring patients whose urines demonstrate large M-spikes
Confirming the quantitation of specimens that show M-spikes by electrophoresis
Detecting urine monoclonal proteins and identification of specimens that need urine protein electrophoresis
A kappa/lambda (K/L) ratio >6.2 suggests the presence of monoclonal kappa light chains.
A K/L ratio <0.7 suggests the presence of monoclonal lambda light chains.
In 24-hour specimens, a >90% increase in concentration suggests progression or relapse; a >90% decrease suggests treatment response.
Increased kappa and/or lambda light chains may be seen in benign (polyclonal) and neoplastic (monoclonal) disorders.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Unlike the electrophoretic M-spike, this immunoassay quantitates both polyclonal and monoclonal light chains and is therefore not sensitive for detecting small monoclonal abnormalities. A normal kappa/lambda (K/L) ratio does not rule out a monoclonal protein, and an abnormal ratio does not identify a monoclonal protein. Urine protein electrophoresis and immunofixation are more sensitive and specific.
The quantitation of urine kappa light chain by immunonephelometry yields results that are approximately 2 times the values from the electrophoresis M-spike. Sequential results should be compared to previous results obtained by the same methodology.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
KAPPA TOTAL LIGHT CHAIN
LAMBDA TOTAL LIGHT CHAIN
Clinical References Provides recommendations for further in-depth reading of a clinical nature
1. International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol 2003;121:749-757
2. Rajkumar SV, Kyle RA: Multiple myeloma diagnosis and treatment. Mayo Clin Proc 2005;80(10):1371-1382
3. Snyder MR, Clark R, Bryant SC, Katzmann JA: Quantitation of urinary light chains. Clin Chem 2008; 54(10):1744-1746