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Diagnostic performances of M-protein tests according to the clinical presentations of kidney disease

      Highlights

      • Sensitivity of M-protein tests differed by the presenting features of kidney disease.
      • M-protein tests showed lower sensitivity in subjects with nephrotic syndrome.
      • Serum IF and the FLC ratio is sufficient as screening in subjects with AUA or CGN.
      • Urine IF can be added for patients who presented with nephrotic syndrome.

      Abstract

      Background

      Screening for monoclonal immunoglobulin (MIg) is critical in patients with kidney disease.

      Methods

      We identified 943 subjects who underwent kidney biopsy and at least one of monoclonal (M)-protein tests (serum and urine electrophoresis [EP], serum and urine immunofixation [IF], and serum free light chain [FLC] ratio). The sensitivities of several combinations of the 5 tests were examined by clinical presentations of kidney disease.

      Results

      The sensitivities of serum EP, urine EP, and the serum FLC ratio were 65%, 68%, and 71%, respectively, which were lower than those of serum IF (79%) and urine IF (87%) to detect MIg. In the nephrotic syndrome (NS) group, the panel including serum IF, urine IF, and the serum FLC ratio exhibited 100% sensitivity to identify MIg in patients with multiple myeloma (MM) or with monoclonal gammopathy of renal significance (MGRS). In subjects without NS, the panel of serum EP and serum FLC ratio detected MIg in all cases of MM, and the serum IF plus serum FLC ratio detected MIg in all cases of MGRS.

      Conclusion

      This study demonstrated that the sensitivity of screening panels differed by the presenting features of kidney disease. The M-protein tests had lower sensitivity for detection of MIg in subjects with NS compared to those with other clinical presentation.

      Keywords

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      References

        • Bridoux F.
        • Leung N.
        • Hutchison C.A.
        • Touchard G.
        • Sethi S.
        • Fermand J.P.
        • et al.
        Diagnosis of monoclonal gammopathy of renal significance.
        Kidney Int. 2015; 87: 698-711
        • Heher E.C.
        • Rennke H.G.
        • Laubach J.P.
        • Richardson P.G.
        Kidney disease and multiple myeloma.
        Clin J Am Soc Nephrol. 2013; 8: 2007-2017
        • Heher E.C.
        • Goes N.B.
        • Spitzer T.R.
        • Raje N.S.
        • Humphreys B.D.
        • Anderson K.C.
        • et al.
        Kidney disease associated with plasma cell dyscrasias.
        Blood. 2010; 116: 1397-1404
        • Kim do H.
        • Lim A.Y.
        • Gwag H.B.
        • Lee J.H.
        • Jung K.S.
        • Lee K.
        • et al.
        A case of Fanconi syndrome accompanied by crystal depositions in tubular cells in a patient with multiple myeloma.
        Kidney Res Clin Pract. 2014; 33: 112-115
        • Hutchison C.A.
        • Batuman V.
        • Behrens J.
        • Bridoux F.
        • Sirac C.
        • Dispenzieri A.
        • et al.
        The pathogenesis and diagnosis of acute kidney injury in multiple myeloma.
        Nat Rev Nephrol. 2012; 8: 43-51
        • Leung N.
        • Bridoux F.
        • Hutchison C.A.
        • Nasr S.H.
        • Cockwell P.
        • Fermand J.P.
        • et al.
        Monoclonal gammopathy of renal significance: when MGUS is no longer undetermined or insignificant.
        Blood. 2012; 120: 4292-4295
        • Sethi S.
        • Zand L.
        • Leung N.
        • Smith R.J.
        • Jevremonic D.
        • Herrmann S.S.
        • et al.
        Membranoproliferative glomerulonephritis secondary to monoclonal gammopathy.
        Clin J Am Soc Nephrol. 2010; 5: 770-782
        • Paueksakon P.
        • Revelo M.P.
        • Horn R.G.
        • Shappell S.
        • Fogo A.B.
        Monoclonal gammopathy: significance and possible causality in renal disease.
        Am J Kidney Dis. 2003; 42: 87-95
        • Dispenzieri A.
        • Kyle R.
        • Merlini G.
        • Miguel J.S.
        • Ludwig H.
        • Hajek R.
        • et al.
        International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders.
        Leukemia. 2009; 23: 215-224
        • Yadav P.
        • Leung N.
        • Sanders P.W.
        • Cockwell P.
        The use of immunoglobulin light chain assays in the diagnosis of paraprotein-related kidney disease.
        Kidney Int. 2015; 87: 692-697
        • Abadie J.M.
        • van Hoeven K.H.
        • Wells J.M.
        Are renal reference intervals required when screening for plasma cell disorders with serum free light chains and serum protein electrophoresis?.
        Am J Clin Pathol. 2009; 131: 166-171
        • Doyle A.
        • Soutar R.
        • Geddes C.C.
        Multiple myeloma in chronic kidney disease. Utility of discretionary screening using serum electrophoresis.
        Nephron Clin Pract. 2009; 111: c7-11
        • Hutchison C.A.
        • Harding S.
        • Hewins P.
        • Mead G.P.
        • Townsend J.
        • Bradwell A.R.
        • et al.
        Quantitative assessment of serum and urinary polyclonal free light chains in patients with chronic kidney disease.
        Clin J Am Soc Nephrol. 2008; 3: 1684-1690
        • Hutchison C.A.
        • Burmeister A.
        • Harding S.J.
        • Basnayake K.
        • Church H.
        • Jesky M.D.
        • et al.
        Serum polyclonal immunoglobulin free light chain levels predict mortality in people with chronic kidney disease.
        Mayo Clin Proc. 2014; 89: 615-622
        • Katzmann J.A.
        • Clark R.J.
        • Abraham R.S.
        • Bryant S.
        • Lymp J.F.
        • Bradwell A.R.
        • et al.
        Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains: relative sensitivity for detection of monoclonal light chains.
        Clin Chem. 2002; 48: 1437-1444
        • Levey A.S.
        • Stevens L.A.
        • Schmid C.H.
        • Zhang Y.L.
        • Castro 3rd, A.F.
        • Feldman H.I.
        • et al.
        A new equation to estimate glomerular filtration rate.
        Ann Intern Med. 2009; 150: 604-612
        • Lakshminarayanan R.
        • Li Y.
        • Janatpour K.
        • Beckett L.
        • Jialal I.
        Detection by immunofixation of M proteins in hypogammaglobulinemic patients with normal serum protein electrophoresis results.
        Am J Clin Pathol. 2007; 127: 746-751
        • Katzmann J.A.
        Screening panels for monoclonal gammopathies: time to change.
        Clin Biochem Rev. 2009; 30: 105-111
        • Park J.W.
        • Kim Y.K.
        • Bae E.H.
        • Ma S.K.
        • Kim S.W.
        Combined analysis using extended renal reference range of serum free light chain ratio and serum protein electrophoresis improves the diagnostic accuracy of multiple myeloma in renal insufficiency.
        Clin Biochem. 2012; 45: 740-744
        • Katzmann J.A.
        • Kyle R.A.
        • Benson J.
        • Larson D.R.
        • Snyder M.R.
        • Lust J.A.
        • et al.
        Screening panels for detection of monoclonal gammopathies.
        Clin Chem. 2009; 55: 1517-1522