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Kidney Int. 2015 Apr;87(4):692-7. doi: 10.1038/ki.2014.333. Epub 2014 Oct 8.

The use of immunoglobulin light chain assays in the diagnosis of paraprotein-related kidney disease.

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1] Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK [2] College of Medical and Dental Sciences, Division of Immunity and Infection, University of Birmingham, Birmingham, UK.
1] Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA [2] Division of Haematology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Medicine/Division of Nephrology, University of Alabama at Birmingham, Birmingham VA Medical Center, Birmingham, Alabama, USA.


Kidney involvement is common in paraprotein-related diseases. A diversity of clinical presentations and histopathological features can occur secondary to tissue injury caused by precipitation or deposition of a clonal immunoglobulin, usually an immunoglobulin light chain. The paraprotein is either produced by multiple myeloma or by a clone of B-cell lineage that does not fulfill diagnostic criteria for multiple myeloma. The recent introduction of serum immunoglobulin free light chain assays, which accurately quantify both light chain isotypes to produce a ratio that indicates the presence or absence of a light chain paraprotein, is a major clinical development. However, as the interpretation of the assay can be challenging, the aim of this review is to clarify the role of serum and urinary light chain assays in the screening and diagnosis of paraprotein-related kidney disease.

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