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Open Access Technical advance

Diagnostic accuracy of monoclonal antibody based serum immunoglobulin free light chain immunoassays in myeloma cast nephropathy

Colin A Hutchison1*, Paul Cockwell1 and Mark Cook2

Author Affiliations

1 Renal Institute of Birmingham, University Hospital and University of Birmingham, Birmingham, UK

2 Department of Haematology, University Hospital Birmingham, Birmingham, UK

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BMC Clinical Pathology 2012, 12:12  doi:10.1186/1472-6890-12-12

Published: 9 August 2012

Abstract

Background

The development of serum immunoassays for the measurement of immunoglobulin free light chains has led to a paradigm shift in the diagnosis, assessment and monitoring of patients with plasma cell dyscrasias. The impact of these immunoassays which employ polyclonal antibodies was most notable for those patients who were previously classified as non-secretory multiple myeloma. Recently new monoclonal antibody based assays have become available. The purpose of this study was to compare the diagnostic sensitivity of these new assays with those already in clinical practice.

Methods

Sera from 30 patients who present with severe acute kidney injury and multiple myeloma were identified for analysis. A head to head comparison of the two commercially available free light chains assays was then undertaken to determine if their diagnostic sensitivity and specificity were comparable.

Results

In this first assessment of the utility of these new assays, we found that one of 17 patients with a lambda monoclonal free light chain resulting in acute kidney injury were not identified and a further 12% of patients were wrongly classified as having levels below those associated with disease specific acute kidney injury.

Conclusion

These results suggest that caution should be applied to the use of new free light chain assays in the assessment of patients with a monoclonal gammopathy.

Keywords:
Acute kidney injury; Multiple myeloma; Free light chain; Cast nephropathy; Serum immunoassays