Hi. My name is Keri. I need some help if anyone else has this experience....
My history: Pigment Dispersion Syndrome, Chronic Sinusitis, (Past)Active MRSA in the nares, GERD, IBS, Celiac Disease, Basal Cell skin cancer with removal, Pre Cervical Cancer with cryosurgery (1997), Uterine Fibroids, Ovarian Cysts, Fibromyalgia (I don't believe him), Hypermobility Joint Syndrome, Bipolar Type 1, Anxiety, OCD, Strep throat, Scarlet Fever, C-Section (2012), Fractured right clavicle (1990), Fractured right hand (1995)
Symptoms: Weakness in legs and arms, numbness tingling in feet, bone pain throughout my body especially where my ribs meet in my back, lower back, hands, and hips. Ataxia, occasional spots in my vision, occasional speaking difficulty, and memory loss. Fatigue throughout the day that gets worse. Inability to lift arms for long periods of time, example brushing hair, easy bruising, nose bleeds, night sweats. Some symptoms started 8 years ago and now these are all current)
Test- All negative Factor VIII Assay, Willebrand, RF Factor, CRP, Sjogrens, ANA, DS DNA, Lyme, Lupus, All vitamin levels. BMP, CBC, Albumin, Protein, Thyroid studies, CK all normal.
Abnormal- AST 34units
Abnormal- Serum (Blood levels) Igm 334, but no M spikes, No Proteins, Immunofixation normal, IFE, Kappa, Lambda Chains all negative and normal.
24 Hour urine- Abnormal- Kappa/Lambda Ratio 0.15 (2.04-10.37) and Free Kappa LT chains 0.97(1.35-24.19)
again no M spikes, no protein at all, IFE normal, Immunoflixation normal, Gamma/Globin all normal.
CT of Chest: 10mm Anterior Mediastinal Tissue representing Thymic Tissue, small hepatic cysts.
Nerve Conduction Test- Negative
Currently seeing a rheumatologist (who I don't like and need a good one), neurologist, neurosurgeon, hematologist/oncologist, GI,
I have labs to rule out Mythesis Gravis this week pending(First 2 of 3 negative, waiting on third result) and an EMG.
My oncologist says there is something is wrong but he has to do more research. He is amazing doctor but says he has never seen a 24 hour urine come back with my result and have no proteins, no Bence Jones Protein, and perfect kidney function.
Any suggestions, anyone know of any further tests that could be done? What is the significance of the kappa/lambda ratio and levels in a 24 hour urine? With all other tests coming back negative.
Any help or suggestions is very appreciated!
Forums
Re: Low kappa/lambda ratio in 24-hour urine with no protein
Wow, you have a lot going on.
So, to be clear, you had a serum freelite chain test? What were your serum Kappa and Lambda values from this test?
While I have excess Lambda free light chains in my blood serum (I have smoldering multiple myeloma), they don't show up in my urine as some fairly unique electrochemical phenomenon is going on that causes them to be rejected by my kidneys (my kidneys are perfectly normal, as verified by a biopsy). Immunoglobulins are too big to make it through your kidneys, so these particular proteins won't show up in one's urine.
Did they also quantify your serum IgG and IgA levels? What were they and what were the reference ranges? What is the normal reference range for your IgM in your lab results?
So, to be clear, you had a serum freelite chain test? What were your serum Kappa and Lambda values from this test?
While I have excess Lambda free light chains in my blood serum (I have smoldering multiple myeloma), they don't show up in my urine as some fairly unique electrochemical phenomenon is going on that causes them to be rejected by my kidneys (my kidneys are perfectly normal, as verified by a biopsy). Immunoglobulins are too big to make it through your kidneys, so these particular proteins won't show up in one's urine.
Did they also quantify your serum IgG and IgA levels? What were they and what were the reference ranges? What is the normal reference range for your IgM in your lab results?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low kappa/lambda ratio in 24-hour urine with no protein
Only labs abnormal have been serum IgM elevation, low alk phos
24 hour urine. Very low abnormal kappa/lambda ratio and decreased kappa free light chains.
My nerve and muscle situation tests were negative and blood tests for MG were negative.
I am very frustrated because I have been going to a primary doctor who has ignored my concerns for years. Finally on my own I started going to specialists and have been doing MRI, CTS, and blood and other various tests for 6 months. I'm tired and frustrating and in pain.
Maybe it's an autoimmune disease that's not showing up on blood work. When I research kappa/lambda all that comes up in myeloma. Just frustrated and depressed. Thank you for your response.
24 hour urine. Very low abnormal kappa/lambda ratio and decreased kappa free light chains.
My nerve and muscle situation tests were negative and blood tests for MG were negative.
I am very frustrated because I have been going to a primary doctor who has ignored my concerns for years. Finally on my own I started going to specialists and have been doing MRI, CTS, and blood and other various tests for 6 months. I'm tired and frustrating and in pain.
Maybe it's an autoimmune disease that's not showing up on blood work. When I research kappa/lambda all that comes up in myeloma. Just frustrated and depressed. Thank you for your response.
Re: Low kappa/lambda ratio in 24-hour urine with no protein
Sorry all my other levels Ig were negative. When I was first diagnosed with Celiac disease, my IgA was elevated, but after 3 years of gluten free diet everything is normal. My labs are finally normal, my anemia has disappeared, and my electrolytes are stable.
Re: Low kappa/lambda ratio in 24-hour urine with no protein
OK, but again:
Did you in fact have a serum Freelite assay done?
And what was the normal reference range for the IgM in your lab results? I am asking because I'm curious just how elevated your IgM is and different labs have different reference ranges, so it is hard to tell just how high "340" is for your IgM without knowing the reference range..
An elevated IgM could possibly indicate Waldnestrom's macroglobulinemia (WM), but only a bone marrow biopsy can confirm this (which is also the golden test for multiple myeloma). You would also need to have a monoclonal IgM spike for WM, which it sounds like you don't have? An elevated IgM can also indicate mono, arthritis and other items. See: http://www.webmd.com/a-to-z-guides/immunoglobulins?page=2
Since you've got a spattering of other conditions, I'm hesitant to even venture a guess. Sorry I couldn't be more help.
Did you in fact have a serum Freelite assay done?
And what was the normal reference range for the IgM in your lab results? I am asking because I'm curious just how elevated your IgM is and different labs have different reference ranges, so it is hard to tell just how high "340" is for your IgM without knowing the reference range..
An elevated IgM could possibly indicate Waldnestrom's macroglobulinemia (WM), but only a bone marrow biopsy can confirm this (which is also the golden test for multiple myeloma). You would also need to have a monoclonal IgM spike for WM, which it sounds like you don't have? An elevated IgM can also indicate mono, arthritis and other items. See: http://www.webmd.com/a-to-z-guides/immunoglobulins?page=2
Since you've got a spattering of other conditions, I'm hesitant to even venture a guess. Sorry I couldn't be more help.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low kappa/lambda ratio in 24-hour urine with no protein
This is a tough situation and I am sorry to hear that you are having difficulty arriving at a diagnosis. It does seem that the appropriate work-up is being done.
Based on what you have presented thus far, it does not seem that there is a monoclonal protein present on testing. I would be sure that you get serum free light chain testing done as Multibilly suggested, but it seems this may have already been done. I would also be sure that immunofixation testing was done on that 24-hour urine specimen.
If all of this has been done and is normal, I would simply repeat it in 3 to 6 months to ensure that a monoclonal protein was not missed with the first pass.
Hang in there!
Pete V.
Based on what you have presented thus far, it does not seem that there is a monoclonal protein present on testing. I would be sure that you get serum free light chain testing done as Multibilly suggested, but it seems this may have already been done. I would also be sure that immunofixation testing was done on that 24-hour urine specimen.
If all of this has been done and is normal, I would simply repeat it in 3 to 6 months to ensure that a monoclonal protein was not missed with the first pass.
Hang in there!
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Low kappa/lambda ratio in 24-hour urine with no protein
Thank you for all your responses.
The normal range for IgM is 48-271 and mine is 334. I have had immunofixation done on my blood and urine and there is no M spike in any samples. I also don't present with organ damage or abnormal electrolytes. No monoclonal peaks are present. I also have had protein electrophoresis done on blood and urine and everything is negative. I do not believe a serum free light chain was done on my blood, unless that is the kappa/lambda ratio, which was negative.
I understand there is a chance it is not a myeloma process, but my hematologist says there is something wrong he just hasn't figured it out yet.
Thank you for all your help.
The normal range for IgM is 48-271 and mine is 334. I have had immunofixation done on my blood and urine and there is no M spike in any samples. I also don't present with organ damage or abnormal electrolytes. No monoclonal peaks are present. I also have had protein electrophoresis done on blood and urine and everything is negative. I do not believe a serum free light chain was done on my blood, unless that is the kappa/lambda ratio, which was negative.
I understand there is a chance it is not a myeloma process, but my hematologist says there is something wrong he just hasn't figured it out yet.
Thank you for all your help.
Re: Low kappa/lambda ratio in 24-hour urine with no protein
KerriAnn,
If you are looking at a lab result that has serum Kappa/Lambda ratio, you should also see the Kappa and Lambda values listed on the same lab report. There is only one kind of serum free light chain test that the FDA approves and this is called the "Freelite Chain Assay". So, if you look closely at the lab report it will probably say it "Freelite" right on the page of that particular test ("Freelite" is a trademarked name of the lab that has the patent on that particular test).
Technically, there is no such thing as "negative" free light chain ratio. It may simply be "normal", "low" or "high".
If you can let us know the kappa, lambda and ratio values, this might help with that piece of the puzzle.
Hope this helps.
If you are looking at a lab result that has serum Kappa/Lambda ratio, you should also see the Kappa and Lambda values listed on the same lab report. There is only one kind of serum free light chain test that the FDA approves and this is called the "Freelite Chain Assay". So, if you look closely at the lab report it will probably say it "Freelite" right on the page of that particular test ("Freelite" is a trademarked name of the lab that has the patent on that particular test).
Technically, there is no such thing as "negative" free light chain ratio. It may simply be "normal", "low" or "high".
If you can let us know the kappa, lambda and ratio values, this might help with that piece of the puzzle.
Hope this helps.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low kappa/lambda ratio in 24-hour urine with no protein
Thank you for all your help. These are my urine and blood results. The only things abnormal are *****
24 hour Urine........
Ur 24 Abnormal Protein Band 3
Result:Not Applicable
Ur 24 Abnormal Protein Band 2
Result:Not Applicable
Ur 24 Abnormal Protein Band 1
Result: No M Spike
U Creatinine Immuno 24hr
Result:1.55
Normal: 0.63-2.50
U Protein/Creatinine Ratio 24hr
Result: Too low to report
Normal: <= 84
**********Kappa/Lambda Ratio,U
Result:0.15 (Low)
Normal: 2.04-10.37
Free Lambda Lt Chains,Ur
Result:6.36 mg/L
Normal: 0.24-6.66
*********Free Kappa Lt Chains,Ur
Result:0.97 mg/L (Low)
Normal: 1.35-24.19
Protein, Urine 24hr
Result: Too low to report
Normal: < 150 mg/day
IFE Note
Result: No abnormal bands, no monoclonal proteins
U Interpretation
Date:March 3, 2014 10:20 a.m. EST
Result: No abnormal peaks
BJ Total Volume
Result:2900 mL
U Gamma Globulin
Result:0 %
U Beta Globulin
Result:0 %
U A2 Globulin
Result:0 %
U A1 Globulin
Result:0 %
U Albumin
Result:100 %
Blood......
Abnormal Protein Band 3
Result: Not Applicable
Abnormal Protein Band 2
Result: Not Applicable
Abnormal Protein Band 1
Result: No M spike
Kappa/Lambda Ratio
Result:0.77
Normal: 0.26-1.65
Free Lambda Lt Chains
Result:12.8 mg/L
Normal: 5.7-26.3
Free Kappa Lt Chains
Result:9.8 mg/L
Normal: 3.3-19.4
Immunofixation Interp Sr
Result: No abnormal bands
Beta 2 Microglobulin
Result:1.47 mg/L
Normal: <= 2.51 mg/L
Total Protein IFE
Result:6.9 g/dL
Normal: 6.1-8.1
Immunofixation
Result: no monoclonal type bands
Gamma Globulin IFE
Result:1.0 g/dL
Normal: 0.6-1.6
Beta Globulin IFE
Result:0.9 g/dL
Normal: 0.8-1.4
Alpha 2 Globulin IFE
Result:0.5 g/dL
Normal: 0.5-1.0
Alpha 1 Globulin IFE
Result:0.2 g/dL
Normal: 0.1-0.3
Albumin IFE
Result:4.3 g/dL
Normal: 3.5-4.7
IgA
Result:245 mg/dL
Normal: 81-463
*********IgM
Result:334 mg/dL (High)
Normal: 48-271
IgG
Result:948 mg/dL
Normal: 694-1618
24 hour Urine........
Ur 24 Abnormal Protein Band 3
Result:Not Applicable
Ur 24 Abnormal Protein Band 2
Result:Not Applicable
Ur 24 Abnormal Protein Band 1
Result: No M Spike
U Creatinine Immuno 24hr
Result:1.55
Normal: 0.63-2.50
U Protein/Creatinine Ratio 24hr
Result: Too low to report
Normal: <= 84
**********Kappa/Lambda Ratio,U
Result:0.15 (Low)
Normal: 2.04-10.37
Free Lambda Lt Chains,Ur
Result:6.36 mg/L
Normal: 0.24-6.66
*********Free Kappa Lt Chains,Ur
Result:0.97 mg/L (Low)
Normal: 1.35-24.19
Protein, Urine 24hr
Result: Too low to report
Normal: < 150 mg/day
IFE Note
Result: No abnormal bands, no monoclonal proteins
U Interpretation
Date:March 3, 2014 10:20 a.m. EST
Result: No abnormal peaks
BJ Total Volume
Result:2900 mL
U Gamma Globulin
Result:0 %
U Beta Globulin
Result:0 %
U A2 Globulin
Result:0 %
U A1 Globulin
Result:0 %
U Albumin
Result:100 %
Blood......
Abnormal Protein Band 3
Result: Not Applicable
Abnormal Protein Band 2
Result: Not Applicable
Abnormal Protein Band 1
Result: No M spike
Kappa/Lambda Ratio
Result:0.77
Normal: 0.26-1.65
Free Lambda Lt Chains
Result:12.8 mg/L
Normal: 5.7-26.3
Free Kappa Lt Chains
Result:9.8 mg/L
Normal: 3.3-19.4
Immunofixation Interp Sr
Result: No abnormal bands
Beta 2 Microglobulin
Result:1.47 mg/L
Normal: <= 2.51 mg/L
Total Protein IFE
Result:6.9 g/dL
Normal: 6.1-8.1
Immunofixation
Result: no monoclonal type bands
Gamma Globulin IFE
Result:1.0 g/dL
Normal: 0.6-1.6
Beta Globulin IFE
Result:0.9 g/dL
Normal: 0.8-1.4
Alpha 2 Globulin IFE
Result:0.5 g/dL
Normal: 0.5-1.0
Alpha 1 Globulin IFE
Result:0.2 g/dL
Normal: 0.1-0.3
Albumin IFE
Result:4.3 g/dL
Normal: 3.5-4.7
IgA
Result:245 mg/dL
Normal: 81-463
*********IgM
Result:334 mg/dL (High)
Normal: 48-271
IgG
Result:948 mg/dL
Normal: 694-1618
Re: Low kappa/lambda ratio in 24-hour urine with no protein
Hi,
I have a extremely similar situation as yours, eg. the symptoms and the biology and my doctors are not able to understand what is happening.
I am quoting the description of your symptoms:
I have exactly the sames ones !!!
Concerning the biology, I also have not monoclonal spike.
And, like in your case, I have only one of the free light chains restricted but the other one is normal. In my case, it is the lambda free light chain that in lowered (0.89, range: 5.70-26.3 ) and the kappa free light chain is normal (8.83, range: 3.3-19.4).
I was wondering if you have had any answers or diagnosis of what was going on in your own case, because this may help me a lot in my quest.
Best regards.
I have a extremely similar situation as yours, eg. the symptoms and the biology and my doctors are not able to understand what is happening.
I am quoting the description of your symptoms:
Symptoms: Weakness in legs and arms, numbness tingling in feet, bone pain throughout my body especially where my ribs meet in my back, lower back, hands, and hips. Ataxia, occasional spots in my vision, occasional speaking difficulty, and memory loss. Fatigue throughout the day that gets worse. Inability to lift arms for long periods of time, example brushing hair, easy bruising, nose bleeds, night sweats.
I have exactly the sames ones !!!
Concerning the biology, I also have not monoclonal spike.
And, like in your case, I have only one of the free light chains restricted but the other one is normal. In my case, it is the lambda free light chain that in lowered (0.89, range: 5.70-26.3 ) and the kappa free light chain is normal (8.83, range: 3.3-19.4).
I was wondering if you have had any answers or diagnosis of what was going on in your own case, because this may help me a lot in my quest.
Best regards.
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