[Kit1018]

Do these lab results indicate amyloidosis or myeloma?

by Kit1018 on Sun Feb 01, 2015 9:29 pm

Hi everyone,

I was on here a few months ago concerned about symptoms and urinanalysis showing light chains [see the earlier discussion thread]. My doctors insisted that the first results were a fluke, so they ran them three times over the past few months. I am not sure if I should worry or what it means. I just had them redone and will share the following results with you:

Urine Albumin (Ref. Range: ?)
Aug 22 2014 Sep 22 2014 Jan 27 2015
22.9% 24.2% 100%

Urine Total Protein (Ref. Range: 0-11 mg/dL)
Aug 22 2014 Sep 22 2014 Jan 27 2015
5 mg/dL 10 mg/dL 7 mg/dL

Urine Free Kappa Light Chains (Ref. Range: 0.0-13.5 mg/L)
Aug 22 2014 Sep 22 2014 Jan 27 2015
22.8 mg/L H 29.7 mg/L H 43.1 mg/L H

Urine Free Lambda Light Chains (Ref. Range: 0.0-5.9 mg/L)
Aug 22 2014 Sep 22 2014 Jan 27 2015
1.0 mg/L 1.7 mg/L 2.1 mg/L

Urine Free Kappa/Lambda Ratio (Ref Range: 0.00-2.30)
Aug 22 2014 Sep 22 2014 Jan 27 2015
22.80 H 17.47 H 20.52 H

To me when reading the results, it looks like the numbers are getting worse, but my doctors aren't wanting to say something is up due to my age. I have had this test run three times because, with each result, they seem to think it is a fluke, although they keep ordering it because the numbers are going up. I know that you guys aren't doctors but would like to hear input on this. Opinions mainly due to the experience you have had.

My blood work was good a few months ago. The only abnormality is in my urine. I want to advocate for myself but don't want my docs to think I'm crazy. I feel that there is something wrong due to these results. What do you think?

Thank you
Kit1018

[Multibilly]

Re: Do these lab results indicate amyloidosis or myeloma?

by Multibilly on Sun Feb 01, 2015 9:43 pm

Kit,

When you say your "blood work was good a few months ago", did you have a Serum Immunofixation (IFE), Serum Protein Electrophoresis (SPEP), and a serum Free Light Chain assay (sFLC) test?

Respectively, did these test reports detect any monoclonal protein, measure any monoclonal protein (aka M-spike or paraprotein) or show an abnormal serum free light chain ratio?

[Kit1018]

Re: Do these lab results indicate amyloidosis or myeloma?

by Kit1018 on Sun Feb 01, 2015 11:14 pm

I had a lot of labs done when I was in the hospital in August. The creatine kinase and pre albumin in my blood and the serum free light chains in my urine came back high. Which is why they have redone them 3x. My light chains in my blood were ok. I have not had that repeated since August. I will post those below.

I am concerned because my Bence Jones protein and albumin are coming back high three times. This was a random urine during the day.

Am I right to be concerned, or is this a test that is not important?

Creatine Kinase (Ref. Range: 0-142 U/L)
Aug 25 2014 268 U/L H
Aug 22 2014 202 U/L H
Aug 22 2014 188 U/L H
Jan 07 2013 130 U/L

Free Kappa Light Chains, Quant (Ref. Range: 3.3-19.4 mg/L)
Aug 22 2014 9.8 mg/L

Free Lambda Light Chains, Quant (Ref. Range: 5.7-26.3 mg/L)
Aug 22 2014 8.8 mg/L

Free Kappa/Lambda Light Chain Ratio (Ref. Range: 0.26-1.65)
Aug 22 2014 1.11

Thank you for your input,
Kit

[Multibilly]

Re: Do these lab results indicate amyloidosis or myeloma?

by Multibilly on Mon Feb 02, 2015 8:50 am

Again, did you have a Serum Immunofixation (IFE) and a Serum Protein Electrophoresis (SPEP) test?

Respectively, did the IFE and SPEP tests detect any monoclonal protein or measure any mono­clonal protein (aka M-spike or paraprotein)?

I'm not as well versed in interpreting urine test results since my doctors don't use urine tests to monitor my disease. As Dr. Hoffman also pointed out in your earlier forum thread:

"As a generalization, abnormal urine free light chain levels alone, with normal serum free light chains, are very rarely associated with a disorder like myeloma or amyloidosis. Urine free light chains are difficult to interpret, and I actually almost never order them. I will order them as part of a 24 hour collection for people with known disease, but never as a screening test".

Also, these urine tests are just random samples and not 24 hour collection tests? 24-hour urine tests (24 hour UPEP), not random sample urine tests, are the kind of urine tests that are sometimes used in conjunction with an SPEP, IFE, etc to help pinpoint a diagnosis of monoclonal gammopathy.

Knowing your serum IFE and serum SPEP results will help determine if you have any sort of monoclonal gammopathy going on. As others mentioned in the earlier post, I might also suggest following up with a hematologist / oncologist that specializes in multiple myeloma.

It's really hard to sort out what's going on with just these pieces of data and a multiple myeloma specialist would be in much better position to do so. Hope this helps a bit.

[Dr. Peter Voorhees]

Re: Do these lab results indicate amyloidosis or myeloma?

by Dr. Peter Voorhees on Mon Feb 02, 2015 9:22 am

Dear Kit1018,

If not done, I would suggest, in addition to what Multibilly has suggested, a 24-hour urine protein electrophoresis and immunofixation to quantify the amount of total protein you are spilling in your urine over a 24-hour period and to determine if there are any monoclonal free kappa light chains in your urine. Just because the kappa light chains are high does not mean they are clonal.

In addition, knowing what your serum creatinine would also be of value.

I think folks in the forum will be able to provide more meaningful input with these results. The urine results you have provided seem to be from random samples?

Thanks!

Pete V.