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Technical Briefs |
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1 Division of Clinical Biochemistry and Immunology,
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Section of Biostatistics,
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Division of Nephrology, and
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Division of Hematology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905;
aauthor for correspondence: fax 507-266-4088, e-mail katzmann.jerry@mayo.edu)
Multiple myeloma is a malignant plasma cell dyscrasia characterized by bone marrow plasmacytosis (1). Malignant plasma cells produce an abnormal monoclonal immunoglobulin, the laboratory hallmark of the disease process, as well as cytokines, which stimulate cells of the bone marrow microenvironment (2)(3). The neoplastic clone and its products cause the dysfunction of several organs, including bone pain or fractures, renal failure, anemia, susceptibility to infection, hyperviscosity, and hypercalcemia (1). However, the most characteristic feature of multiple myeloma and other monoclonal gammopathies is the presence of a serum and/or urinary monoclonal (M) component on immunofixation (4). Approximately two-thirds of patients with a serum M component also have Bence Jones proteins (BJPs) in the urine. In almost 20% of myelomas, only immunoglobulin light chains are present in the serum and/or urine and are often designated as light chain multiple myeloma (LCMM).
Renal failure occurs in 
25% of myeloma patients, and there is some renal pathology in more than one-half (1)(5)(6). The number of patients with renal disease varies considerably depending on the criteria used to define renal impairment. Serum creatinine concentrations remain in the reference interval until the glomerular filtration rate is reduced by almost 50%; therefore, the data obtained with blood creatinine concentrations most likely underestimate the incidence of renal involvement in myeloma. Data using the estimated creatinine clearance rate (7), which takes into account various variables, including patient age, weight, and gender, indicate that approximately one-half of patients have renal insufficiency at the time of diagnosis (5). The nature of the M component is also associated with the prevalence of renal disease (5)(8)(9). In light chain myeloma, 65% of patients have impaired renal function
Acknowledgments
References
The following articles in journals at HighWire Press have cited this article:
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  H. Rozemuller, E. van der Spek, L. H. Bogers-Boer, M. C. Zwart, V. Verweij, M. Emmelot, R. W. Groen, R. Spaapen, A. C. Bloem, H. M. Lokhorst, et al. A bioluminescence imaging based in vivo model for preclinical testing of novel cellular immunotherapy strategies to improve the graft-versus-myeloma effect Haematologica, July 1, 2008; 93(7): 1049 - 1057. [Abstract] [Full Text] [PDF]
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 M. R. Nowrousian, D. Brandhorst, C. Sammet, M. Kellert, R. Daniels, P. Schuett, M. Poser, S. Mueller, P. Ebeling, A. Welt, et al. Serum Free Light Chain Analysis and Urine Immunofixation Electrophoresis in Patients with Multiple Myeloma Clin. Cancer Res., December 15, 2005; 11(24): 8706 - 8714. [Abstract] [Full Text] [PDF]
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 M. A. Gertz Managing Myeloma Kidney Ann Intern Med, December 6, 2005; 143(11): 835 - 837. [Full Text] [PDF]
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 M. Q. Lacy, W. J. Hogan, M. A. Gertz, A. Dispenzieri, S. V. Rajkumar, S. Hayman, S. Kumar, M. R. Litzow, and A. L. Schroeter Successful Treatment of Scleromyxedema With Autologous Peripheral Blood Stem Cell Transplantation Arch Dermatol, October 1, 2005; 141(10): 1277 - 1282. [Abstract] [Full Text] [PDF]
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 J. A. Viedma, N. Garrigos, and S. Morales Comparison of the Sensitivity of 2 Automated Immunoassays with Immunofixation Electrophoresis for Detecting Urine Bence Jones Proteins Clin. Chem., August 1, 2005; 51(8): 1505 - 1507. [Full Text] [PDF]
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S. V. Rajkumar, R. A. Kyle, T. M. Therneau, L. J. Melton III, A. R. Bradwell, R. J. Clark, D. R. Larson, M. F. Plevak, A. Dispenzieri, and J. A. Katzmann Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance Blood, August 1, 2005; 106(3): 812 - 817. [Abstract] [Full Text] [PDF]
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A. R. Bradwell Serum Free Light Chain Measurements Move to Center Stage Clin. Chem., May 1, 2005; 51(5): 805 - 807. [Full Text] [PDF]
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J. R. Tate, D. Gill, R. Cobcroft, and P. E. Hickman Practical Considerations for the Measurement of Free Light Chains in Serum Clin. Chem., August 1, 2003; 49(8): 1252 - 1257. [Abstract] [Full Text] [PDF]
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M. Salomo, P. Gimsing, and L. B. Nielsen Simple Method for Quantification of Bence Jones Proteins Clin. Chem., December 1, 2002; 48(12): 2202 - 2207. [Abstract] [Full Text] [PDF]
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R. S. Abraham, M. C. Charlesworth, B. A.L. Owen, L. M. Benson, J. A. Katzmann, C. B. Reeder, and R. A. Kyle Trimolecular Complexes of {lambda} Light Chain Dimers in Serum of a Patient with Multiple Myeloma Clin. Chem., October 1, 2002; 48(10): 1805 - 1811. [Abstract] [Full Text] [PDF]
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G. Marien, E. Oris, A. R. Bradwell, N. Blanckaert, and X. Bossuyt Detection of Monoclonal Proteins in Sera by Capillary Zone Electrophoresis and Free Light Chain Measurements Clin. Chem., September 1, 2002; 48(9): 1600 - 1601. [Full Text] [PDF]
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