[Celiac]

Monoclonal gammopathy of renal significance

by Celiac on Wed Sep 02, 2015 1:37 pm

I found this article on Blood that throws me for a little.

N Leung et al, "Monoclonal gammopathy of renal significance: when MGUS is no longer undetermined or insignificant," Blood, Nov 2012 (full text)

I was diagnosed with MGUS in 2007 at the Cleveland Clinic. I've been monitored yearly since then. I have an IgA kappa free light chain MGUS.

Protein, urine - 22 mg/dl (above high threshold) Range: <12
Prot/creat ratio - 207 mgPR/gCR (above high threshold) Range: <200
Kappa free - 2.34 mg/dl (above high threshold) Range: 0.33-1.94
Lambda free - 1.07 mg/dl Range: 0.57-2.63
Kappa / lambda ratio - 2.19 (Above high threshold) Range: 0.26-1.65

Comments: In patients with chronic kidney disease or renal impairment, the reference range of kappa/lambda free light chain ratio is 0.37-3.10.

So should I be finding a nephrologist because the article says "Renal impairment is a defining criterion of multiple myeloma. Aside from a serum creatinine > 2.0 mg/dL attributable to the plasma cell dyscrasia, the current guidelines do not define the renal disease any further."

I love the research Mayo does and follow it all the time but I live in Chicago, darn.

[TerryH]

Re: Monoclonal gammopathy of renal significance

by TerryH on Wed Sep 02, 2015 7:45 pm

Hi Celiac,

What is your serum creatinine level? Does it indicate you have kidney damage?

Even if there are signs of kidney damage, my understanding of "monoclonal gammopathy of renal significance" is that, for the diagnosis to be made, a biopsy has to indicate that the kidney damage that has occurred is due to the deposition of immunoglobulins in the kidney. In other words, there has to be a link between the monoclonal gammopathy and the kidney damage.

Do you have a monoclonal immunoglobulin (M-spike) and, if so, what is it? It would be labeled as one or more "abnormal protein bands", or an "M-spike", on the results of your serum protein electrophoresis test.

[Celiac]

Re: Monoclonal gammopathy of renal significance

by Celiac on Thu Sep 03, 2015 9:39 am

M PROTEIN 0.2 g/dl (Above high threshold) Range: 0.0

all other blood tests urine test normal range

Thanks for your help

[TerryH]

Re: Monoclonal gammopathy of renal significance

by TerryH on Thu Sep 03, 2015 10:00 am

With that low of an M-spike and serum free light chain levels that are just barely out of range, it seems unlikely that your MGUS is causing any kidney damage. This would also be suggested by the fact that your serum creatinine level apparently is normal, given that you said that "all other blood tests" are normal.

I'd look closer at your serum creatinine level to check where exactly it is in the normal range. Is it at the high end of the normal range, in the middle, etc.? If it's at the high end, it could be a sign of potential kidney damage.

The most important thing, though, is to track most of your key lab results over time. If you can, plot them. I would track your immunoglobulin levels, your M-spike, your serum free light chain results (levels and ratio), and your serum creatinine, calcium, and hemoglobin levels. Tracking and plotting these values will let you see if there are any trends, and also will help you better determine if new test results are unusual, or within the normal range of how your test results bounce around.

Good luck!

[Celiac]

Re: Monoclonal gammopathy of renal significance

by Celiac on Thu Sep 03, 2015 7:46 pm

Terry,

I appreciate your response. The health system I belong to graphs all my results and I started about where I am now, went down lower, and was told by my hematologist I did not need to be followed yearly anymore. Of course, I knew this was not true, so now my rheumatologist runs my blood work.

It's just that lately I am so tired I am dozing off in a chair – something I would never do – and I have been having more back pain, hip pain, and a strange left side pain in my back along with horrid fatty diarrhea. I have celiac disease and watch what I eat very carefully. But lately I have no desire to eat because of this increased pressure feeling under my sternum. I'm planning a follow up upper GI very soon. I've read in the posts here :

The Mayo Clinic identified 3 factors that will influence progression from MGUS to multiple myeloma:

1. Non-IgG isotype
2. Serum M protein greater than 1.5 g/dL
3. Kappa / lambda or lambda/kappa ratio being skewed, or out of normal range.

For patients with 0 of these major risk factors, the risk of progression at 20 years is 5%. For patients with 1, the risk factor is 21%. For those having 2 of these conditions, it's 37%, and for those meeting all three of those criteria, it's 58%.

According to my results, kappa / lambda or lambda / kappa ratio is above normal for the lab that ran mine.

Kappa / lambda ratio 2.19 (Above high threshold) range: 0.26-1.65

and my

Protein, urine 20 mg/dl (Above high threshold) Range: <12
Prot / creat ratio 207 mgPR/gCR (Above high threshold) Range: <200

Proteinuria is characteristic of renal disease, and concentrations may be increased with diabetes, hypertension, nephritic syndrome, and drug nephrotoxicity.

I had a bone survey in 2007 but not a CT, MRI, or bone marrow biopsy. So even though my results are much lower than what I have read here, why flag them as "Above High Threshold" if they really are still too low?

Thanks again.