[Ali1977]

Re: Low kappa FLC & low kappa / lambda FLC ratio

by Ali1977 on Thu Apr 09, 2015 7:11 pm

Hi Everyone,

I wanted to give you an update in regards to my tests.

Following my unusual low kappa numbers and low kappa / lambda ratio in early February, I took your advice and asked my GP to order the following tests until my appointment with a hematologist. Specially since I've been dealing with a very mild back pain, some mild bone pain and muscle spasms, which I never had before. I got the following results last week:

Immunoglobulins

IgG 8.6 (6.7-15.2) g/L
IgA 0.83 (0.70-4.00) g/L
IgM 1.37 (0.40-2.30) g/L

Total Protein 73 (62-82) g/L
Albumin 48.9 (34.0-53.0) g/L
Alpha 1 Globulin 1.7 (1.3-3.5) g/L
Alpha 2 Globulin 6.5 (5.0-11.0) g/L
Beta 1 Globulin 5.7 (4.0-6.6) g/L
Beta 2 Globulin 2.6 (1.8-4.8) g/L
Gamma Globulin 7.7 (5.1-15.0) g/L
Test Comment: Normal pattern. No paraprotein band is seen on electrophoresis and pattern appears unremarkable.

24 Hour Urine Collection
Total Volume 3.350 (0.600-2.400) L (HIGH)
Urine Creatinine 24h 14.0 (7.0-18.0) mmol/d
Concentration Factor 80 X
Urine Protein 24h 0.34 (0.00-0.15) g/d (HIGH)
Test Comment: Trace albumin and globulins.

Calcium 2.58 (2.10-2.55) mmol/L (HIGH)
Calcium Ionized 1.31 (1.10-1.30) mmol/L (HIGH)
PTH 4.9 (<7.0) pmol/L

Creatinine 90 (60-115) umol/L
Estimated GFR 93 (>59) mL/min
Phosphate 1.26 (0.8-1.45) mmol/L
Alkaline Phosphatase 62 (30-135) U/L
Gamma GT 46 (15-80) U/L
ALT 45 (10-80) U/L
Muscle Enzymes CK 723 (40-275) U/L (HIGH)

At this point, he said he can rule out multiple myeloma or MGUS as all other tests seem normal. However, he said he needs to investigate the high serum calcium levels, high protein level in urine, and also high CK. He was still concerned about my abnormal FLC results, so he ordered another FLC test, which I just got the results yesterday. This time they are normal:

Kappa Free Light Chains 5.7 (3.3-19.4) mg/L
Lambda Free Light Chains 11.6 (5.7-26.3) mg/L
Kappa Free Light Chains / Lambda Free Light Chains 0.49 (0.26-1.65)

Now I am not sure if first time abnormal kappa & lambda results were lab error or these numbers actually fluctuate this much. I am wondering if I should ask for another set of tests in couple of months just to confirm things. My GP suggested cancelling my appointment with the hematologist, which is in July, as he says everything related to the blood is normal.

[Multibilly]

Re: Low kappa FLC & low kappa / lambda FLC ratio

by Multibilly on Thu Apr 09, 2015 8:25 pm

Ali,

I'm not a doc, but I might suggest concentrating on the other issues you mentioned instead of re-testing your free light chains. Some sort of autoimmune disease (there are many) comes to mind when you mention back pain, proteinuria, hypercalcemia and an elevated CK. But, again, I'm not a doc.

[Dr. Adam Cohen]

Re: Low kappa FLC & low kappa / lambda FLC ratio

by Dr. Adam Cohen on Sun Apr 12, 2015 4:59 pm

I agree these labs don't appear suggestive of myeloma.

Elevated CK can reflect a muscle disorder or muscle inflammation, but is not specific for this. The amount of proteinuria is fairly mild and can also be seen in numerous disorders, including common ones like hypertension and diabetes.

If the symptoms and lab abnormalities persist without explanation found by your primary care physician, evaluation by a rheumatologist may be helpful.