[sandra256]

Re: 26 years old, may have multiple myeloma

by sandra256 on Wed Apr 08, 2015 3:53 pm

Sorry, I forgot to the mention the value of the A/G (PEP) value. It's 1.32.

[Tracy J]

Re: 26 years old, may have multiple myeloma

by Tracy J on Wed Apr 08, 2015 4:41 pm

Sandra,

So let me make sure I understand this. You have already been diagnosed with mes­an­gio­pro­lifera­tive glomerulonephritis, based on swelling and protein in your urine, and ultimately a kid­ney biopsy, is that right?

Since light chains are cleared by the kidney, if you have significant kidney disease such as glomeru­lo­neph­ritis, it will impair clearance of the light chains, and so they will rise in the testing. It is important to note that BOTH light chains rise because they are not being cleared, NOT be­cause they are being produced in a faulty manner. In myeloma, they rise because they are being produced in a faulty manner - and usually only ONE (lambda or kappa) will rise, while the other one stays normal.

This is why the ratio between the two types of light chains (kappa and lambda) is important to look at. If one light chain is rising, but the other is not – as in myeloma – the ratio will become abnormal. On the other hand, if neither type of light chain is being cleared appropriately, they will both rise in equal proportions, and the ratio will remain normal. This happens in primary kidney diseases such as glomerulonephritis.

So, based on this, I would say that right now you should chase the glomerulonephritis, not myeloma. Did the doctor make any recommendations to treat the glomerulonephritis?

Have you ever had a bone marrow biopsy? (Sorry if you already addressed this elsewhere.)

Tracy

[sandra256]

Re: 26 years old, may have multiple myeloma

by sandra256 on Wed Apr 08, 2015 6:13 pm

Traci

Thank you for your response. The only medicine that I am on right now is lisinopril, for high blood pressure. I do not have high blood pressure but my nephrologists recommended it to me due to the fact that it protects the kidneys, it has however helped reduce the protein in my urine. Currently it is less than 1 gram a day. She had planned to put me on prednisone but decided to wait until I saw the hematologists. I am very new to the whole kidney problems and do not know much about multiple myeloma, as you can tell. She was very concerned about my free kappa and lambda light chains being higher than normal, but a little confused about the ratio being in the normal range. This is the reason I am trying to get as much information as I can because she did mention that myeloma could be the cause of my injured kidneys. As far as the SPEP and UPEP test what do seem to indicate?

[Multibilly]

Re: 26 years old, may have multiple myeloma

by Multibilly on Wed Apr 08, 2015 7:05 pm

Hi Sandra,

As usual, I agree with Tracy's comments. The test results you've posted don't seem to suggest multiple myeloma either.

See: https://en.wikipedia.org/wiki/Immunoglobulin_light_chain

"The exact normal ratio of kappa to lambda, according to a novel polyclonal free light chain assay, ranges from 0.26 to 1.65. Both the kappa and the lambda chains can increase pro­por­tion­ately, maintaining a normal ratio. This is usually indicative of something other than a blood cell dys­crasia, such as kidney disease."

[antelope1225]

Re: 26 years old, may have multiple myeloma

by antelope1225 on Tue Apr 14, 2015 4:45 pm

Hi Tracy and Multibilly.

I appreciated your explanation for why not to worry if both kappa and lambda free light chains rise but the ratio stays normal.

I have wondered about that situation - and it makes sense that the kidneys are having trouble clearing them.

Thanks!

Cathy

[sandra256]

Re: 26 years old, may have multiple myeloma

by sandra256 on Tue Apr 21, 2015 4:19 pm

Mutibilly and Traci,

Thank you so much for the information provided about renal clearance and free light chains. I have done some more research myself and I keep coming across the same information you all provided. About the two light chains being elevated and that it is usually due to something else rather then multiple myeloma.

I am really hoping that this turns out to be true in my case and that my nephrologist is just exaggerating and that this is something else she wants to rule out. Since we have done so many other blood work to see what is causing the MesPGN and nothing has came back positive other than the free light chains. According to my kidney biopsy, my problem is secondary, now the problem is finding what is causing this in order to hopefully put a stop or at least slow the progression.

I finally go a call from the hematologist. I will be seeing him on the 1st of May, I will keep you guys updated. Wish me luck that I can soon find the cause to my problem, whether it's multiple myeloma or something else.

Once again, thank you!