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Free light chain ratio in patients with chronic renal failure


Authors: P. Kušnierová 1,2;  D. Zeman 1,2;  O. Michnová 1;  F. Všianský 1;  D. Stejskal 1,2;  V. Bartoš 1,2;  T. Jelínek 3;  R. Hájek 3
Authors‘ workplace: Ústav laboratorní diagnostiky, Oddělení klinické biochemie, Fakultní nemocnice Ostrava 1;  Katedra biomedicínských oborů, Lékařská fakulta, Ostravská univerzita 2;  Hematoonkologická klinika, Fakultní nemocnice Ostrava 3
Published in: Klin. Biochem. Metab., 28, 2020, No. 4, p. 144-149

Overview

Objective: Patients with chronic kidney disease (CKD) often show an increased serum free light chains concentration (FLC) accompanied by changes in the representation of both forms, i.e., kappa and lambda chains, and consequently by changing their ratio (FLC ratio). The aim of this study was to verify the reference limits of this ratio in patients with chronic renal failure, determined by commercial IVD of Binding Site.

Design: Methodological study.

Settings: Institute of Laboratory Diagnostics, Department of Clinical Biochemistry, University Hospital Ostrava.

Material and methods: The study included 150 patients with CKD and 17 controls. The concentration of creatinine, FLC kappa, FLC lambda was determined, the estimate of glomerular filtration according to CKD-EPI and serum FLC ratio were calculated according to the KDIGO classification, divided into groups G2 to G5. To exclude the presence of monoclonal FLC, serum protein electrophoresis, immunofixation electrophoresis and isoelectric focusing in agarose gel followed by affinity immunoblotting with antibodies against free kappa and lambda light chains (IEF / AIB) were used. Excel, MedCalc and Project R software were used for statistical data processing.

Results: Statistically significant differences were observed between concentrations of FLC kappa, FLC lambda and FLC ratio in individual groups (P < 0.0001). These parameters also statistically significantly correlated with creatinine concentration and with the estimate of glomerular filtration according to CKD EPI (P < 0.0001). In accordance with CLSI guideline EP28-A3C, the following reference limits were established for the FLC ratio in patients with CKD: a lower limit of 1.01 and an upper limit of 3.65.

Conclusion: Practical application of reference limits for the FLC ratio may increase the specificity of the FLC test for the detection of monoclonal FLC production in patients with CKD. The limits in this study were estimated using Binding Site diagnostics and may not be the same for other diagnostics.

Keywords:

Free light chains of immunoglobulins – immunoturbidimetry – Creatinine – enzymatic determination – estimation of glomerular filtration – reference limit – CKD


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