[coffeekiss]

Slightly elevated kappa light chain level, normal ratio

by coffeekiss on Wed Apr 26, 2017 10:27 pm

Hey, all!

I'll try to keep this short and sweet! I am a 29-year-old female diagnosed with multiple sclerosis 3 years ago. I was pregnant in 2016 and the doctors noticed protein in my urine from the get-go. They initially thought it meant I was going to develop pre-eclampsia, but my blood pressure was always fine and I never did. I was closely monitored throughout my pregnancy and was induced at 39 weeks.

At my 6 week postpartum appointment, I still had protein in my urine. By now I was feeling terrible pain in all my joints. My knees, elbows, ankles, hips, hands, fingers. Sometimes neck. I was so fatigued. She told me she thought it was something rheumatological.

The rheumatologist did a work up of some labs and found nothing abnormal. She did a chest x-ray, all normal. My ESR was 20 multiple myeloma/hr, which is the highest range of normal. She felt I may be developing a kidney issue, so she then sent me to a nephrologist.

The nephrologist did blood work and urine tests. My protein was at about 2 g, not quite enough to be considered nephrotic (3 g). My joint pains were deep to the bone and continued. It hurt to walk, sit, move, all that. She started me on enalapril to contain the protein and ordered an serum protein electrophoresis (SPEP) and urine protein electrophoresis (UPEP). I did not have the M-protein and for my SPEP, the only thing that was elevated was the kappa light chain. Normal was 3-19 and mine was 25.

The ratio was normal, so she told me we could rule out myeloma. She feels I am dealing with something rheumatological and that the protein is secondary to something inflammatory, so she sent me back to the rheumatologist, who now also wants to look at the possibility I may have lupus.

Why would my kappa light chain be elevated if I don't have myeloma? Do I need to ask to take another look at the possibility of myeloma?

The nephrologist did not seem concerned in the slightest, but I want to be 100% certain when eliminating each possibility while we try to get to a diagnosis as to what is going on with me and what is causing the joint pain and proteinuria.

I know it would be atypical considering my age, but it isn't impossible.

Any thoughts on this would be great. I am so tired of being bounced around from specialist to specialist!

[Multibilly]

Re: Slightly elevated kappa light chain level, normal ratio

by Multibilly on Thu Apr 27, 2017 7:53 am

Hi Coffeekiss,

Welcome to the forum.

Inflammation and infections can throw off one's free light chain numbers. So don't assume that an elevated kappa free light chain means that you have a monoclonal gammopathy.

The key tests to rule out a monoclonal gammopathy are your serum immunofixation and SPEP tests. Note that the SPEP would tell you your m-protein value (m-spike), IF you have one. But it doesn't sound like you have one from what you said here, which is good news. The serum immunofixation test won't tell you your m-protein level, but it will very accurately tell you if you have any m-protein in your system.

See this table to understand how to interpret your free light chain values. Barring any renal impairment issues, it sounds like you likely have a polyclonal gammopathy (pIg). pIg can indeed be caused by systemic lupus erythematosus (SLE) and some other non-cancerous conditions.

Good luck and let us know how things turn out.

fl-interp01-lg.gif (58.65 KiB) Viewed 14751 times

[coffeekiss]

Re: Slightly elevated kappa light chain level, normal ratio

by coffeekiss on Thu Apr 27, 2017 12:46 pm

Thank you so much for this chart. This is exactly what I was looking for. I couldn't seem to find a clear answer through google.

I have found more answers and information from this forum than I have with any doctor.

Thanks again, and I hope this post proves useful to someone else in my situation looking for answers here in the future!

[WholeNotherWorld]

Re: Slightly elevated kappa light chain level, normal ratio

by WholeNotherWorld on Thu Apr 27, 2017 9:58 pm

Thanks Mutibilly! Great chart.