My mother recently had some abnormal test results and has been referred to an hematologist / oncologist. She was having some issues with elevated blood pressure. Her GP referred her out to a urologist, who did some blood work and a 24-hour urine assay. I think the initial refer out was due to hematuria. Urologist also ordered CT.
CT was positive for unpassable kidney stone.
Urine assay showed 6.7 M-spike, 4435 mg/24 hr creatinine, 321 creatinine clearance, Protein total for 24 hr urine was 3305, all other values in normal range.
Bloodwork flagged only glucose at 109, M-spike was not observed.
Urologist then referred to hematology / oncology doctor.
I know an M-spike of that high in the urine is not good. But to show none in the serum, I don't understand that.
Creatinine and protein high in urine due to kidney stone?
I am paramedic student, know little about lab results of this nature.
How worried should we be?
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Re: M-spike in urine but not blood: is that possible?
Hi heartnc,
Welcome to the forum.
These measurements can be confusing.
The M-spike that is measured in urine is quite different than then M-spike that is measured in the blood serum. The urine M-spike measures monoclonal free LIGHT chains (aka Bence Jones proteins, aka monoclonal kappa or lambda free light chains in the urine ). On the other hand, the serum M-spike measures monoclonal HEAVY chains (i.e., monoclonal IgA, IgG, etc). Whoever decided to use the same name for these very different monoclonal protein types ought to be shot
With this understanding, a person can present with only monoclonal free light chains (i.e., with no serum M-spike, but a positive urine M-spike). This happens about 20% of the time in myeloma patients.
Therefore, the first thing you want to do is to get a more complete set of blood work that also looks at the serum free light chain numbers and a serum immunofixation test. The serum immunofixation test will tell you very accurately if any monoclonal protein (heavy or light chain) is present in the blood. The serum free light chain assay will tell given you an idea of how much monoclonal free light protein you might have in your blood.
Additionally, I have read of at least one case on this forum where a urine M-spike was detected, yet the blood work was fine. I've never understood how that could happen.
If the oncologist thinks that there is a likelihood that myeloma might be in play, he/she would likely also order a bone marrow biopsy, which is the golden test for detecting the presence of myeloma.
Hope this helps.
Welcome to the forum.
These measurements can be confusing.
The M-spike that is measured in urine is quite different than then M-spike that is measured in the blood serum. The urine M-spike measures monoclonal free LIGHT chains (aka Bence Jones proteins, aka monoclonal kappa or lambda free light chains in the urine ). On the other hand, the serum M-spike measures monoclonal HEAVY chains (i.e., monoclonal IgA, IgG, etc). Whoever decided to use the same name for these very different monoclonal protein types ought to be shot
With this understanding, a person can present with only monoclonal free light chains (i.e., with no serum M-spike, but a positive urine M-spike). This happens about 20% of the time in myeloma patients.
Therefore, the first thing you want to do is to get a more complete set of blood work that also looks at the serum free light chain numbers and a serum immunofixation test. The serum immunofixation test will tell you very accurately if any monoclonal protein (heavy or light chain) is present in the blood. The serum free light chain assay will tell given you an idea of how much monoclonal free light protein you might have in your blood.
Additionally, I have read of at least one case on this forum where a urine M-spike was detected, yet the blood work was fine. I've never understood how that could happen.
If the oncologist thinks that there is a likelihood that myeloma might be in play, he/she would likely also order a bone marrow biopsy, which is the golden test for detecting the presence of myeloma.
Hope this helps.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: M-spike in urine but not blood: is that possible?
It does help! 
I told her that when she sees a hematologist / oncologist to try and delay a bone marrow biopsy until new and more detailed blood work is done. If blood work comes back ok, I wouldn't think a bone marrow biopsy would be needed.
Just hate for her to go through that if it isn't for sure needed.
I myself had to see a hematologist / oncologist for splenomegaly. First thing they wanted to do was a bone marrow biopsy. I pushed for further bloodwork, which all came back fine. No bone marrow biopsy needed.
Spleen just decided to be irregular for a little while due to a virus.
I told her that when she sees a hematologist / oncologist to try and delay a bone marrow biopsy until new and more detailed blood work is done. If blood work comes back ok, I wouldn't think a bone marrow biopsy would be needed.
Just hate for her to go through that if it isn't for sure needed.
I myself had to see a hematologist / oncologist for splenomegaly. First thing they wanted to do was a bone marrow biopsy. I pushed for further bloodwork, which all came back fine. No bone marrow biopsy needed.
Spleen just decided to be irregular for a little while due to a virus.
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