My calcium serum was mildly elevated (10.4) 2 months in a row, so my doc decided to test further.
All of my serum levels are in the normal range. However, in my 24-hour urine test, the kappa free light chains was 1.02 (1.35-24.19 normal) and my lambda free light chains was 0.09 (0.24-6.66 normal) and the kappa-lambda ratio was mildly high at 11.33 (2.04-10.37). My calcium serum returned to a normal range of 9.8.
What does this mean? All I can find when searching free light chains is issues when HIGH, not low as mine are. I have no symptoms of any illnesses.
Thanks!
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Re: Kappa & lambda free light chains both low - meaning?
Hello Magelsoph,
This won't completely address your question, but – partly for everyone else here in the forum – it's important to note that the results you've posted are free light chains measured based on a urine test.
Most of the free light chain results that you will find discussed here in the forum, and in the literature related to multiple myeloma, are free light chain test results based on a blood (serum) sample.
We're assuming that the free light chain results you've posted are from a urine test not just because you said so in your posting, but also because the "normal" ranges you've quoted are basically the same as those quoted in this reference sheet from the Mayo Medical Laboratories website.
There, the reference ranges for the urine free light chain test results are given as follows:
Free Urinary Kappa Light Chains: 0.14-2.42 mg/dL = 1.4-24.2 mg/L
Free Urinary Lambda Light Chains: 0.02-0.67 mg/dL = 0.2-6.7 mg/L
Free Urinary Kappa/Lambda Ratio: 2.04-10.37 (ratio)
Again, we know this doesn't answer your question, but it should clarify things a bit as a basis for other postings.
This won't completely address your question, but – partly for everyone else here in the forum – it's important to note that the results you've posted are free light chains measured based on a urine test.
Most of the free light chain results that you will find discussed here in the forum, and in the literature related to multiple myeloma, are free light chain test results based on a blood (serum) sample.
We're assuming that the free light chain results you've posted are from a urine test not just because you said so in your posting, but also because the "normal" ranges you've quoted are basically the same as those quoted in this reference sheet from the Mayo Medical Laboratories website.
There, the reference ranges for the urine free light chain test results are given as follows:
Free Urinary Kappa Light Chains: 0.14-2.42 mg/dL = 1.4-24.2 mg/L
Free Urinary Lambda Light Chains: 0.02-0.67 mg/dL = 0.2-6.7 mg/L
Free Urinary Kappa/Lambda Ratio: 2.04-10.37 (ratio)
Again, we know this doesn't answer your question, but it should clarify things a bit as a basis for other postings.
Re: Kappa & lambda free light chains both low - meaning?
Magelsoph,
I really don't think that the change in your calcium numbers is all that significant when I compare your numbers to mine. I'm smoldering and my calcium level has bounced all over the place in the past 2 years.
Below are my serum calcium values measured every 8-10 weeks over the past 2+ years. If you are interested, this data set has a standard deviation of 0.4 mg./dL (that is, I can expect a normal fluctuation of +/- 0.4 mg/dL around the average, which is 9.8 mg/dL).
9.60
9.90
9.9
10.3
10.5
9.9
8.8
10.2
9.4
10.2
9.4
9.7
9.4
9.5
9.9
10.0
I really don't think that the change in your calcium numbers is all that significant when I compare your numbers to mine. I'm smoldering and my calcium level has bounced all over the place in the past 2 years.
Below are my serum calcium values measured every 8-10 weeks over the past 2+ years. If you are interested, this data set has a standard deviation of 0.4 mg./dL (that is, I can expect a normal fluctuation of +/- 0.4 mg/dL around the average, which is 9.8 mg/dL).
9.60
9.90
9.9
10.3
10.5
9.9
8.8
10.2
9.4
10.2
9.4
9.7
9.4
9.5
9.9
10.0
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Kappa & lambda free light chains both low - meaning?
Sorry if I posted incorrectly, this is my first post. I'm not sure exactly how I should have phrased my question since I did refer to the results as being from urine. Any suggestions?
Multibilly,
These are the first I've ever had any variance from normal in calcium numbers. Not sure how to interpret your reply as your calcium numbers look pretty close to normal. What does that mean with regard to your diagnosis?
Multibilly,
These are the first I've ever had any variance from normal in calcium numbers. Not sure how to interpret your reply as your calcium numbers look pretty close to normal. What does that mean with regard to your diagnosis?
Re: Kappa & lambda free light chains both low - meaning?
Hi Magelsoph,
You phrased your question fine. We just wanted to make sure everyone was clear that your free light chain levels were the result of urine measurement, rather than serum free light chain testing. It's an important difference, but one that could be overlooked because most people here are used to seeing free light chain results reported based on blood tests.
Can you clarify something, however. Have you been diagnosed in the past with multiple myeloma, or with MGUS (monoclonal gammopathy of undetermined significance)? Or was the urine test done because you don't have myeloma or MGUS, but you had a high calcium level on a routine blood test, and your doctor decided to investigate potential causes of the high calcium level?
We were assuming that it was the second set of circumstances that led to your urine free light chain tests, but perhaps that assumption is wrong.
You phrased your question fine. We just wanted to make sure everyone was clear that your free light chain levels were the result of urine measurement, rather than serum free light chain testing. It's an important difference, but one that could be overlooked because most people here are used to seeing free light chain results reported based on blood tests.
Can you clarify something, however. Have you been diagnosed in the past with multiple myeloma, or with MGUS (monoclonal gammopathy of undetermined significance)? Or was the urine test done because you don't have myeloma or MGUS, but you had a high calcium level on a routine blood test, and your doctor decided to investigate potential causes of the high calcium level?
We were assuming that it was the second set of circumstances that led to your urine free light chain tests, but perhaps that assumption is wrong.
Re: Kappa & lambda free light chains both low - meaning?
You are exactly correct. I've not been diagnosed with anything. Doc just did the more extensive labs to follow up on the mildly elevated calcium. He tested for abnormalities in the thyroid and parathyroid and added the urine test, I believe because my brother passed two years ago (age 53) from CLL. I think he's just being cautious.
I just don't understand the math that takes the kappa free light chains in urine and the lambda free light chains in urine, which are both below normal, and gets the result ratio of 11.3 which is elevated.
From reading this forum, I find nothing related to a multiple myeloma diagnosis with LOW numbers in the urine and NORMAL numbers in the serum. Thanks for your patience!
I just don't understand the math that takes the kappa free light chains in urine and the lambda free light chains in urine, which are both below normal, and gets the result ratio of 11.3 which is elevated.
From reading this forum, I find nothing related to a multiple myeloma diagnosis with LOW numbers in the urine and NORMAL numbers in the serum. Thanks for your patience!
Re: Kappa & lambda free light chains both low - meaning?
Hi Magelsoph,
The bottom line on the absolute levels and ratio of URINE free light chains is that they are not currently used to diagnose or follow multiple myeloma. The ratio of free light chains in URINE is meaningless.
Borderline elevated levels of calcium are not rare. I agree with evaluating you for possible hyperparathyroidism, etc. Perhaps you should be referred to an endocrinologist to check on the elevated calcium.
To diagnose multiple myeloma, the serum calcium must be far more elevated than your testing showed. The calcium level that must be seen to support a diagnosis of myeloma is a serum calcium of >1 mg/dL higher than the upper limit of normal, or >11 mg/dL.
I think you are OK unless your SPEP or serum free light chains are abnormal.
Thank you for contacting the Beacon with your question !
The bottom line on the absolute levels and ratio of URINE free light chains is that they are not currently used to diagnose or follow multiple myeloma. The ratio of free light chains in URINE is meaningless.
Borderline elevated levels of calcium are not rare. I agree with evaluating you for possible hyperparathyroidism, etc. Perhaps you should be referred to an endocrinologist to check on the elevated calcium.
To diagnose multiple myeloma, the serum calcium must be far more elevated than your testing showed. The calcium level that must be seen to support a diagnosis of myeloma is a serum calcium of >1 mg/dL higher than the upper limit of normal, or >11 mg/dL.
I think you are OK unless your SPEP or serum free light chains are abnormal.
Thank you for contacting the Beacon with your question !
-
Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: Kappa & lambda free light chains both low - meaning?
Dr. Libby, thanks for the clarification.
My internist suggested that I may need to see a hematologist and have a bone marrow biopsy, but wanted to first retest my urine, results pending. He admittedly stated that he's not a specialist. I believe he's being cautious due to my brother's history of disease. Considering that my serum free light chains are in the normal range and my serum calcium has returned to normal, I will see what my doc's plan is for me. I'm grateful that he's conservative and cautious. (Incidentally, I was the donor for my brother's stem cell transplant, and Dr R Nash was the physician for my portion of the transplant.
)
Thanks again, and I will update if there's any pertinent information.
My internist suggested that I may need to see a hematologist and have a bone marrow biopsy, but wanted to first retest my urine, results pending. He admittedly stated that he's not a specialist. I believe he's being cautious due to my brother's history of disease. Considering that my serum free light chains are in the normal range and my serum calcium has returned to normal, I will see what my doc's plan is for me. I'm grateful that he's conservative and cautious. (Incidentally, I was the donor for my brother's stem cell transplant, and Dr R Nash was the physician for my portion of the transplant.
)Thanks again, and I will update if there's any pertinent information.
8 posts
• Page 1 of 1