[luverofpeanuts]

May be starting my journey

by luverofpeanuts on Tue Jan 26, 2016 11:51 pm

I'm landed here while researching ... and decided to register because I may be hanging out for a while.

I'll try to be brief

I'm a 47 year old white male, in pretty decent shape. During a routine physical, my creatinine was found to be slightly high, and my eGFR to be lower than it should be (no other issues of concern that I know of). After ultrasounds for both kidneys and bladder were clear, more blood tests were ordered, my doctor ordered more blood and urine tests.

I have not spoken with the doctor yet, but when reviewing my lab results online, I noticed some other lab results were out of range.

Lambda Free Light Chain, S 1.98 mg/dL
Kappa Free Light Chain, S 3.99 mg/dL
Kappa/Lambda FLC Ratio 2.02

Kappa Total Light Chain,U 2.64 mg/dL
Kappa/Lambda TLC Ratio, U > 3.77
Lambda Total Light Chain,U < 0.7000 mg/dL

The kappa values are what I was researching and found this site and am wondering what to think of next. I haven't had a face-to-face meeting with my doc yet, but I get the feeling he's tracking something. I'm doing a 24-hour urine collection today too.

On a positive note, some other lab results from today made me encouraged that my kidneys may not be in bad shape after all. These cystatin C based values, versus creatinine-based values are well in the normal range.

Cystatin C, S. 1.02 mg/L
eGFR by Cystatin C 80 mL/min/BSA

Of course, i'm eager to get in sync with my doctor to figure out where this is going. While trying not to jump too far ahead of things, I'll say it seems I may have luckily "stumbled" onto these elevated kappa light chain values and can monitor them closely to determine when more proactive action is necessary.

This site has a wealth of information and I feel I know a lot more about what I may be asking my doctor about now.

-- luverofpeanuts (Greg in Rochester, MN, USA)

Attachments

labs.pdf

my lab values

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[JPC]

Re: May be starting my journey

by JPC on Wed Jan 27, 2016 7:13 am

Hello Greg,

Unless you have already had it, you should get the serum protein electrophoresis (SPEP) test, in addition to your 24-hour urine test. The SPEP will measure the "monoclonal protein" level (that is, the bad protein that the multiple myeloma produces), also know as the M-spike. For normal healthy persons, ideally the M-spike is zero, but many people actually have a small M-spike and do not know about it, as they get older.

On the good side, your hemoglobin is very good. Your kappa free light chain level, as you note, is a little high, but I am guessing it's probably inconclusive.

Good luck. JPC

[Multibilly]

Re: May be starting my journey

by Multibilly on Wed Jan 27, 2016 9:11 am

Hi Greg,

You really can't draw any conclusions about having a potential plasma cell disorder (which is what we all have in one form or another on this site) without knowing if there is monoclonal protein present in your system. Other things like an infection can cause a slight rise in one's free light chain numbers.

It would be peculiar if the doctor were to order a free light chain assay without an accompanying serum electrophoresis and serum immunofixation test (maybe you simply don't have copies of those tests?). In any case, you definitely want those two tests, in addition to what is known as a quantified immunoglobulin test.

Between the serum electrophoresis and serum immunofixation test, the serum immunofixation test is the more accurate test for detecting the presence of monoclonal protein. However, the serum immunofixation won't tell you how much monoclonal protein you might have in your blood – which is what the electrophoresis test tells you. The 24 hour urine test can provide some additional clues, but it is not a substitute for getting the tests I mentioned above.

Wishing you all the best with your upcoming appointment.

[luverofpeanuts]

Re: May be starting my journey

by luverofpeanuts on Wed Jan 27, 2016 9:31 am

Thanks for the info, JPC & Multibilly. Right now, I feel like I'm jumping way too far ahead of things ... trying not to . The doc only says they looking for a reason for the abnormal creatinine and eGFR. He's out this week, so I imagine it will be a while before follow up for these tests. I'm eager to keep things rolling though. My creatinine was found elevated back in November, so I feel this is dragging on a bit slower than I'd want.

Again, thanks for the info.

[luverofpeanuts]

Re: May be starting my journey

by luverofpeanuts on Wed Jan 27, 2016 4:49 pm

Multibilly wrote:

Other things like an infection can cause a slight rise in one's free light chain numbers.

I was thinking about that comment more. I have had a rather lengthy low-grade infection for a long time. I had a dermatology consult in 2011 that indicated an inflammation / infection. I thought it was just acne or rosacea. I was given antibiotics for three months. It helped, but it did come back after a while; it just seems like an annoying acne to me (reddish nose). I did note that during my physical that I was interested in pursuing treatment for that again, if it was back. I'll make a point to ask about that again when I see the doc.

Thanks again.

[luverofpeanuts]

Re: May be starting my journey

by luverofpeanuts on Thu Jan 28, 2016 9:52 am

I was checking for any info on the 24-hour urine collection I dropped off and decided to scan the full lab results again. I found the following ... either I missed them the first few times I checked the patient portal, or they took a little longer to complete.

Immunofixation - no monoclonal protein detected.

Impression, serum protein electrophoresis - no apparent monoclonal protein on serum electro­phoresis. See immunofixation.

Alpha-1 globulin - 0.2 g/dL
Alpha-2 globulin - 0.8 g/dL
Gamma-globulin - 1.3 g/dL

I think those are all encouraging values? Yes?

[Ted Kan]

Re: May be starting my journey

by Ted Kan on Thu Jan 28, 2016 1:56 pm

I agree with JPC and Multibilly. You need a serum protein electrophoresis to see if you have an M-spike. Multibilly has also given you a possible explanation for your elevated light chains that doesn't involve myeloma.

Let me add that many conditions, most far more common than myeloma, can cause a slow decline in GFR. These include high blood pressure, diabetes mellitus, and chronic use of non steroidal anti inflammatory drugs like Aleve (naproxen) and ibuprofen.

[luverofpeanuts]

Re: May be starting my journey

by luverofpeanuts on Fri Jan 29, 2016 3:32 pm

Ted Kan wrote:

I agree with JPC and Multibilly. You need a serum protein electrophoresis to see if you have an M-spike. Multibilly has also given you a possible explanation for your elevated light chains that doesn't involve myeloma.

If I'm reading things right, it seems I have no m-spike detected. See the attachments.

Let me add that many conditions, most far more common than myeloma, can cause a slow decline in GFR. These include high blood pressure, diabetes mellitus, and chronic use of non steroidal anti inflammatory drugs like Aleve (naproxen) and ibuprofen.

I'm waiting to here from my doc to follow up for the latest results. I have had fairly regular use of NSAIDs for many years. Not all the time, but a few times a week during heavy sports activity weeks. I ended NSAID use last November after eGFR was found low.

Suffice it to say, there are a lot of things to consider and I just need to sit tight and wait to hear the plan from my doc.

Thanks again for the comments.

Labs-2016-01-15.pdf

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Labs-2016-01-26.pdf

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[luverofpeanuts]

Re: May be starting my journey

by luverofpeanuts on Thu Feb 04, 2016 2:16 pm

As I monitor my patient portal, I saw documentation for the hematology consult. Good news I think, but will summarize here.

#1 Elevated creatinine, unknown etiology
#2 No evidence of monoclonal plasma cell disorder

Elevated free K/L ratio is secondary to renal failure; it is within renal range of normal (upper limit is 4.0). Nothing to suggest clonal plasma cell disorder or multiple myeloma.

If creatinine elevation is not felt to be due to NSAIDs and HTN a referral to nephrology is suggested.

I'll be waiting for a call from my primary for next steps.

--lo