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Kidney disease and plasma cell dyscrasias: ambiguous cases solved by serum free light chain dimerization analysis

  • Olga Kukuy
  • Batia KaplanEmail author
  • Sizilia Golderman
  • Alexander Volkov
  • Adrian Duek
  • Merav Leiba
  • Ilan Ben-Zvi
  • Avi Livneh
Original article

Abstract

Background

Plasma cell dyscrasias (PCD) comprise a wide spectrum of disorders, which may adversely affect the kidney. However, in some PCD cases associated with kidney disease, the routine laboratory tests may be incapable to determine precisely the form of PCD, i.e., benign or malignant. Moreover, the kidney biopsy needed for precise diagnosis may be risky or declined. To overcome these limitations, we have developed and reported a new non-invasive technique based on serum free light chains (FLC) monomer (M) and dimer (D) pattern analysis (FLC MDPA), which allowed differentiation between malignant and benign PCD forms. The objective of our retrospective study was to demonstrate the utility of FLC MDPA in solving ten puzzling PCD cases complicated with kidney disease (patients 1–10).

Methods

Ten patients with uncertain form of PCD or with a questionable response to treatment were studied. In addition to routine laboratory tests and clinical evaluation of the PCD patients, our previously developed FLC MDPA in sera and biochemical amyloid typing in biopsy tissues were applied.

Results

The FLC MDPA aided the diagnosis of the PCD underlying or accompanying the kidney disease in patients 1–5, and helped to interpret properly the response to treatment in patients 1, 6–10. The FLC MDPA findings were confirmed by a biochemical analysis of tissue amyloid deposits and subsequently by the outcome of these patients.

Conclusions

FLC MDPA is a non-invasive diagnostic test useful in the management of ambiguous cases of PCD associated with kidney disease.

Keywords

Free light chains Amyloidosis Kidney diseases 

Notes

Acknowledgements

We would like to thank Dr. R. Kaplan for his invaluable advice and helpful discussion in the preparation of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 2982-16-SMC) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study (retrospective), formal informed consent was not required.

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Copyright information

© Japanese Society of Nephrology 2019

Authors and Affiliations

  1. 1.Dialysis Unit, Institute of Nephrology and HypertensionSheba Medical CenterRamat GanIsrael
  2. 2.Laboratory of FMF and Amyloidosis, Heller Institute of Medical ResearchSheba Medical CenterRamat GanIsrael
  3. 3.Institute of PathologySheba Medical CenterRamat GanIsrael
  4. 4.Hematology InstituteSheba Medical CenterRamat GanIsrael
  5. 5.Hematology DepartmentAssuta Medical CenterAshdodIsrael
  6. 6.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  7. 7.Department of Internal Medicine FSheba Medical CenterRamat GanIsrael

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