Urinary Findings in Renal Light Chain–Derived Amyloidosis and Light Chain Deposition Disease

Melmed, Gavin M.; Fenves, Andrew Z.; Stone, Marvin J.

doi:10.3816/clm.2009.n.046

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…In a first study, the combination of a Bence-Jones proteinuria and a severe albuminuria was described as a hint for AL or MIDD [26] . In accordance with these data, only slightly elevated albuminuria or IgG excretion in the urine in the presence of a Bence-Jones proteinuria was an indicator for MCN in our study.…”

Section: Discussionmentioning

confidence: 99%

Screening and Differential Diagnosis of Renal Light Chain-Associated Diseases

Gerth¹,

Sachse

Busch

et al. 2011

Kidney Blood Press Res

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Background: Renal involvement in the light chain-associated diseases multiple myeloma (MM), amyloidosis (AL) and monoclonal immune position disease (MIDD) is common and differential diagnosis usually requires renal biopsy. The aim of this study was to investigate if noninvasive methods are viable to identify and differentiate between the various types of kidney diseases. Patients and Methods: All patients with a light chain-associated disease admitted to our center from 1996 to 2008 were retrospectively evaluated. Renal biopsy data were correlated with proteinuria findings. Results: Only the ratio of free ĸ/λ light chains showed a good sensitivity for myeloma cast nephropathy (MCN), AL and MIDD. The λ light chain was characteristic for AL, the ĸ light chain dominated in MIDD. Renal function at the time of diagnosis was worst in MIDD. MCN presented with a proteinuria of >3.5 g/g creatinine. In contrast, a higher proteinuria was found in AL or MIDD. Whereas the ĸ/λ ratio in the urine was pathological for all three diseases, extremely high or low ratios indicated the presence of MCN. However, in AL or MIDD, the ratio was only moderately elevated. Conclusion: A noninvasive differentiation between MCN and other forms of renal light chain disease is possible.

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Section: Discussionmentioning

confidence: 99%

Screening and Differential Diagnosis of Renal Light Chain-Associated Diseases

Gerth¹,

Sachse

Busch

et al. 2011

Kidney Blood Press Res

View full text Add to dashboard Cite

show abstract

“…Patients with suspected AL amyloid or LCDD should undergo serum and urine protein electrophoresis with immunofi xation, 24-hour urine protein measurement, skeletal survey, serum-free light chain analysis, and bone marrow biopsy. Unless a patient has preexisting renal disease, the presence of signifi cant albuminuria (>600 mg/day) in combination with Bence Jones proteinuria strongly suggests either AL amyloidosis or LCDD (11). While serum and urine studies may be suggestive, the diagnosis of amyloidosis is established through biopsy of an aff ected organ.…”

Section: Diagnosismentioning

confidence: 99%