[wilson2cat]

M-spike with high urine calcium-to-creatinine ratio

by wilson2cat on Sun Dec 03, 2017 11:15 am

I have an oncology appointment tomorrow. I've been reading very interesting posts here.

My story: I moved to a new state, with a new primary care physician. Had annual physical with basic labs, mammogram, and bone density exam.

Basic labs okay, doctor's office called and stated she wanted me to come in for additional testing because my bone density exam showed osteoporosis in lumbar spine. She wanted to make sure that the osteoporosis was not caused by anything other than menopause. (I have had osteopenia at every bone density exam since I began having them in my early 40s). Had bloodwork and a spot urinalysis.

Called by doctor herself to alert me that SPEP showed an M-protein spike (0.5 g/dl), referring me to oncologist to rule out multiple myeloma. Also, lots of calcium in my urine and asked me to submit a 24-hour urine to evaluate calcium in urine. 24-urine showed abnormal calcium-to-creatinine ratio (365) range 200-260. Referring me to an endocrinologist.

Nervous about oncology appointment and wondering if these two abnormalities are related. I have lumbar pain, but know that it is due to 3 bulging discs, degenerative disc disease, and spinal stenosis. Have random sharp pains in hips, legs, and arms occasionally, but think maybe arthritis. Mild fatigue, but I am an active 60-year-old nurse doing very physical work alongside 30-year-old nurses.

Wondering if the oncologist will be ordering additional labs and imaging.

[Multibilly]

Re: M-spike with high urine calcium-to-creatinine ratio

by Multibilly on Sun Dec 03, 2017 2:44 pm

Hi Susan,

Welcome to the forum.

I would imagine that your oncologist will order up a serum immunofixation, serum free light chain assay, and quantitative immunoglobulin (IgG, IgA, IgM) test, given your 0.5 g/dL M-spike. He may also suggest an MRI of your spine or a PET/CT to better evaluate your spine. Note that a 0.5 g/dL M-spike is not that high and may only be suggestive of something like MGUS, so I wouldn't jump to a conclusion that you might have symptomatic multiple myeloma.

Did your 24-hour urine test flag any other anomalies other than a high calcium/creatinine ratio? I would assume that the 24-hour test would have included an electrophoresis and immunofixation test to look for any monoclonal proteins in your urine, given that you have a serum M-spike. Myeloma tends to often cause monoclonal proteins to show up in the urine (aka a "urine M-spike") and will therefore also increase the total urine protein count. But while myeloma can cause high serum calcium levels, I don't believe that it also normally increases urine calcium levels (somebody else on the forum may know better about this point).

I'm guessing that you are also being referred to an endocrinologist to help rule out hyperparathyroidism as a cause for your hypercalcemia.

Also, how are your serum creatinine and hemoglobin levels doing? You will find these values on your comprehensive metabolic and CBC blood tests, respectively. These serum values can sometimes be thrown off by myeloma.