Small trial suggests the scans might help, but experts aren't so sure
by kristigirl on Tue Jan 10, 2012 01:48 AM
I am a 37 yr. old and as of yet, am undiagnosed. I started seeing a new hematologist last week for what I thought was an unrelated clotting disorder.
In September 11, I saw a nephrologist due to consistently having blood in my urine. He ran a Kappa/Lamda Urine test and found my Kappa/Lamda ratio to be a little elevated at 13.59. My prior hematologist wasn't concerned about it, but he re-ran the test and also a Kappa/Lamda blood test. My Kappa/Lamda U ratio came back elevated again, but at a lower level of 10.someth ing. The Kappa/Lambda blood test was normal. A peripheral blood smear showed a mild left-shift.
My new hematologist (my prior one left the area), said he thinks I have had undiagnosed Smoldering MM for the last 6 years based on my history. I have a history of blood clots (2006), anemia, consistent mildly elevated WBC, a history of hypogammaglobulinanemia. I have showed IgG deficancies of subclass 1, 2 and 4, although IgG levels have been in the normal range the last year or so. I also had a rib fracture in early 2010 for unknown reasons. I had back surgery in Sept. and have had trouble with my incision healing (it is finally almost healed now). The Dr. that did my surgery said some of my bone was so degenerated he had to pick slivers of it out of my spinal fluid, but he saw no reason to do any pathology.
The hematologist feels due to the elevated KL ratio that I am transitioning to MM, although I have nothing showing in my blood and no M spike. I had a bone survey last Thursday and am scheduled for a BMB this Thursday.
I guess I think my hematologist is a good doctor, but I am wondering if he is jumping to conclusions. I should add this will be my 3rd BMB since 06. All they have ever shown is hypercellularity with left shift, and my last one showed no iron stores, but I was pregnant when it was done.
So does an elevated KL ratio Urine always mean MM?
Thanks for your thoughts, I appreciate any insight!
by TJW60 on Tue Jan 10, 2012 09:09 PM
Welcome......Here is an article on free light chains that might answer some ?'s for you......
Human immunoglobulin molecules consist of two identical heavy chains which define immunoglobulin classes (IgG, IgA, IgM, IgD and IgE) and identical light chains (kappa or lambda) that are covalently linked to a heavy chain. In healthy individuals, the majority of light chains in serum exist bound to heavy chain. However, low levels of free light chains (FLCs) are found in serum of normal individuals due to their excess production over heavy chains by mature B-cells. In serum, FLC kappa exists predominantly as a monomer with a molecular weight of 22.5 kDa and FLC lambda as a dimer with a molecular weight of 45 kDa. This size difference results in a differential glomerular filtration rate and, consequently, a ratio of FLC kappa to FLC lambda of 1:1.6 in serum.
FLCs are observed in urine too but filtration and reabsorption of low molecular proteins in the kidney strongly affects the FLC concentration so that urinary FLC level is low in healthy individuals.
FLC are a natural product of B lymphocytes and, as such, represent a unique biomarker of neoplastic and reactive B cell-related disorders. Increased FLCs are associated with malignant plasma dyscrasia and other lymphocyterelated immunoproliferative disorders.
The detection of the FLCs is important diagnostic aid for a variety of monoclonal gammopathies, such as multiple myeloma, Waldenstrom macroglobulinemia, nonsecretory myeloma, smoldering multiple myeloma, monoclonal gammopathy of undetermined significance. Accurate measurement of monoclonal free light chains in serum and/or urine is especially important in light-chain diseases, such as light-chain myeloma, primary systemic amyloidosis, and light chain-deposition disease. The ability to quantify monoclonal FLCs may be useful to monitor the disease. In patients with light chain myeloma, either of light chain, kappa or lambda, is dominantly produced and resulting in marked changes of the FLC κ/λ ratio in the early phase of the disease. The detection of urinary monoclonal kappa or lambda free light chains of immunoglobulin, also know as Bence Jones proteins (BJP), are important for identifying and monitoring Bcell malignancies too.
In addition, compared with the healthy state, the synthesis of polyclonal FLC is markedly increased in conditions associated with B cell activation as found in certain inflammatory or autoimmune diseases (e.g. systemic lupus erythematosus, rheumatoid arthritis, or multiple sclerosis, as well as in cancer, diabetes mellitus, and AIDS
Don't dx yourself leave that to your Dr. Get all the info you can and all the test that will indicate whether or not you have MM......Have you had any mri's, pet/ct scans? full skeletol x-rays? bmb are not the most accurate test due to the disease being spotty.
good luck to you
by kristigirl on Wed Jan 11, 2012 03:07 AM
Thank you so much for the article-it was very informative and helped with my understanding. I have searched on the internet and found alot of info on serum k/l ratios, but not much about urine. With all my medical issues I have learned that if I have an understanding of my lab/tests results before follow-up appointments I know what questions I want to ask about them as they pertain to my history. It also keeps my anxiety levels down before appointments.
My bone/skeletal survey that was done last week was normal, as was the Beta2 Microglobulin and Uric Acid tests. Only thing abnormal was my elevated WBC. So I am happy with those results! It will be interesting on Thursday to hear if those results have changed my doctors thoughts on me, and how he thinks we need to proceed going forward.
Again, thanks so much for your reply!
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