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Serum free light chain assessment in monoclonal gammopathy and kidney disease

Nature Reviews Nephrology volume 5, pages 621–628 (2009)Cite this article

Abstract

Abnormalities of immunoglobulin free light chains (FLCs) are frequently present in patients with monoclonal gammopathies and can cause kidney disease. The recent introduction of highly sensitive immunoassays that measure FLCs to levels below those present in normal individuals has provided a new tool for diagnosis and management in this setting. Here, we review the biology of FLC production in health and disease, and the utility of FLC immunoassays in the assessment of monoclonal gammopathies in kidney disease.

Key Points

  • Serum free light chain (FLC) immunoassays can identify monoclonal FLCs with high sensitivity and specificity

  • The screening of serum alone using serum protein electrophoresis and measuring serum κ and λ FLC levels will identify all patients with multiple myeloma and 99% of patients with AL amyloidosis

  • Concentrations of serum polyclonal FLCs are GFR dependent and increase with increasing renal impairment

  • The monitoring of serum FLCs provides an insight into the response to treatment of patients with acute kidney injury and myeloma

  • Renal recovery from cast nephropathy is associated with a significant reduction in serum FLC levels

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Figure 1: An antibody molecule showing heavy and light chain structure, together with free κ and λ light chains.
Figure 2: Serum κ:λ FLC ratios to identify patients with κ or λ light-chain-only multiple myeloma.
Figure 3: Serum FLC concentrations in patients with CKD.
Figure 4: Screening algorithm for suspected monoclonal gammopathies.

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. and Department of Infection and Immunity, Renal Institute of Birmingham, University Hospital Birmingham, University of Birmingham, Birmingham, UK

    Colin A. Hutchison, Kolitha Basnayake & Paul Cockwell

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Correspondence to Colin A. Hutchison.

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Hutchison, C., Basnayake, K. & Cockwell, P. Serum free light chain assessment in monoclonal gammopathy and kidney disease. Nat Rev Nephrol 5, 621–628 (2009). https://doi.org/10.1038/nrneph.2009.151

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