My mother, 65, suffered an acute kidney injury, creatinine going up to 3.3 from 1.4 a week ago, with proteinuria developing from low microalbuminaria.
Free kappa 77 mg/dL (normal up to 24)
Free lambda 24 mg/dL (normal up to 6.6)
We had the lab done at Quest, which lists 2-10 ratio as normal, so the ratio is normal.
She has IgG for EBV, CMV and B19 with recurring low grade fever.
Doctors are unwilling to check current viral culture or IgM for CMV. Her Hgb dropped to 8 from 10 last month despite 40,000 Procrit.
What can be wrong, as the hematologists we visited in New Jersey all gave the wrong test (total light chain instead of free light chain) and they all said nothing to worry about.
Appreciate the help!
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Re: Elevated serum and urine light chains
Hi,
Sorry to hear about you mom's situation.
To summarize, she has:
Very low hemoglobin *
Very high creatinine *
Elevated free light chains in her urine. Note that urine free light chain measurements are notoriously inaccurate. Was there any mention of "Bence Jones" proteins being found? Was this a 24-hour collection urine test?
* Both are at levels sufficient for a diagnosis of symptomatic multiple myeloma (if that is the underlying cause). I'm not a doc, but these seem like pretty worrisome levels, IMHO.
Note that IgG for EMV and CMV titers are different tests than the IgG measurement test that one uses to screen for multiple myeloma. You really want a quantified IgG / IgA / IgM test to screen for multiple myeloma.
How is her calcium level doing (you can find this on her metabolic panel)? Please include units of measure and reference ranges when posting any lab values.
Given the above, I would suggest going to a different facility ASAP and seeing a hematologist who specializes in multiple myeloma to at least definitively rule out multiple myeloma. Here are some facilities in NJ (others on the forum will likely chime in with their recommendations):
https://myelomabeacon.org/resources/treatment-centers/#New%20Jersey
The additional tests you want to help rule out multiple myeloma are as follows:
Serum protein electrophoresis
Serum immunofixation
Serum free light chain
Quantified immunoglobulin (IgG, IgA, IgM)
Sorry to hear about you mom's situation.
To summarize, she has:
Very low hemoglobin *
Very high creatinine *
Elevated free light chains in her urine. Note that urine free light chain measurements are notoriously inaccurate. Was there any mention of "Bence Jones" proteins being found? Was this a 24-hour collection urine test?
* Both are at levels sufficient for a diagnosis of symptomatic multiple myeloma (if that is the underlying cause). I'm not a doc, but these seem like pretty worrisome levels, IMHO.
Note that IgG for EMV and CMV titers are different tests than the IgG measurement test that one uses to screen for multiple myeloma. You really want a quantified IgG / IgA / IgM test to screen for multiple myeloma.
How is her calcium level doing (you can find this on her metabolic panel)? Please include units of measure and reference ranges when posting any lab values.
Given the above, I would suggest going to a different facility ASAP and seeing a hematologist who specializes in multiple myeloma to at least definitively rule out multiple myeloma. Here are some facilities in NJ (others on the forum will likely chime in with their recommendations):
https://myelomabeacon.org/resources/treatment-centers/#New%20Jersey
The additional tests you want to help rule out multiple myeloma are as follows:
Serum protein electrophoresis
Serum immunofixation
Serum free light chain
Quantified immunoglobulin (IgG, IgA, IgM)
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Elevated serum and urine light chains
Thanks for the reply.
I have suspected the same for 5 months now since random urine tests found Bence Jones and ESR was in 90s, but 24-hour showed both lambda kappa elevation. Serum free light chains are also both 3x normal. I started her on curcumin 1 g/day as I still search for a myeloma specialist (trying to get appointment with Dr Joshua Richter at Hackensack).
For 5 months, 3 different hematologists and multiple nephrologists told me this is due to diabetes. Her b2m level is at 4.4 even after creatinine level went down to her base level 1.4 on prednisone (suspected vasculitis) and curcumin. Took her to Hackensack ER last night but they discharged in the morning without calling hematologist. Previously I was even told at another hospital that her ESR is 90 for diabetes. At that time her hgb was 11.
I feel that some hematologists are interested in giving weekly Procrit shot and not interested in curing the patient with kidney failure symptoms. Everyone blames diabetes, even though she had no proteinuria and preserved GFR for her age prior to the kidney failure last August.
There is no M-spike in urine or blood and IgA, IgG and IgM levels are normal, though IgG on the high end and IgM on the low side. Went to multiple rheumatologist due to ANA 160 titre that went away with prednisone, but no one screened for current CMV / Lyme disease etc even though we asked and she has arthlargia and sudden neuropathy that only improves with curcumin and prednisone.
Thanks for the response. My gut feeling is that the elevated light chains are associated with a mild form of amyloidosis from familial Mediterranean fever. She has repeated low grade fever and persistent weakness for 2 years now, and doctors keep blaming diabetes for that as well, even with tight control of sugar
I have suspected the same for 5 months now since random urine tests found Bence Jones and ESR was in 90s, but 24-hour showed both lambda kappa elevation. Serum free light chains are also both 3x normal. I started her on curcumin 1 g/day as I still search for a myeloma specialist (trying to get appointment with Dr Joshua Richter at Hackensack).
For 5 months, 3 different hematologists and multiple nephrologists told me this is due to diabetes. Her b2m level is at 4.4 even after creatinine level went down to her base level 1.4 on prednisone (suspected vasculitis) and curcumin. Took her to Hackensack ER last night but they discharged in the morning without calling hematologist. Previously I was even told at another hospital that her ESR is 90 for diabetes. At that time her hgb was 11.
I feel that some hematologists are interested in giving weekly Procrit shot and not interested in curing the patient with kidney failure symptoms. Everyone blames diabetes, even though she had no proteinuria and preserved GFR for her age prior to the kidney failure last August.
There is no M-spike in urine or blood and IgA, IgG and IgM levels are normal, though IgG on the high end and IgM on the low side. Went to multiple rheumatologist due to ANA 160 titre that went away with prednisone, but no one screened for current CMV / Lyme disease etc even though we asked and she has arthlargia and sudden neuropathy that only improves with curcumin and prednisone.
Thanks for the response. My gut feeling is that the elevated light chains are associated with a mild form of amyloidosis from familial Mediterranean fever. She has repeated low grade fever and persistent weakness for 2 years now, and doctors keep blaming diabetes for that as well, even with tight control of sugar
Re: Elevated serum and urine light chains
Went to Hackensack main hospital and attending oncologist still not sure. Heart ventricles are stiffening, kidney issues, and they still claim that these light chain levels are okay for CKD level. So I give her curcumin and her creatinine goes to normal levels ~1.2.
Should I continue home therapy instead of standard melphalan prescribed by MD for a diagnosis I have to prove with fat biopsy? Should I trust the treatment?
Should I continue home therapy instead of standard melphalan prescribed by MD for a diagnosis I have to prove with fat biopsy? Should I trust the treatment?
Re: Elevated serum and urine light chains
Hi,
My mother has serum b2m level of 4.4 and serum kappa lambda increased level with normal ratio. Polyclonal pattern in SPEP. 24 hour urine saying m spike at b region. What does it mean?
"Urine protein electrophoresis is significant for an M component in the beta region that measures 4% (4.6 mg/dL, 73.6 mg/24 hour urine) of the total urine protein. Clinical correlation recommended."
My mother has serum b2m level of 4.4 and serum kappa lambda increased level with normal ratio. Polyclonal pattern in SPEP. 24 hour urine saying m spike at b region. What does it mean?
"Urine protein electrophoresis is significant for an M component in the beta region that measures 4% (4.6 mg/dL, 73.6 mg/24 hour urine) of the total urine protein. Clinical correlation recommended."
5 posts
• Page 1 of 1