Multiple myeloma can be accurately diagnosed in acute kidney injury patients using a rapid serum free light chain test

BMC Nephrology

Research Article

Meena Shemar¹  Jennifer L. J. Heaney²  Ann E. Griffin²  Mark T. Drayson²  John P. Campbell³  Punit Yadav⁴  Jennifer H. Pinney⁴ 

[1] Abingdon Health Ltd., York, UK;Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Birmingham, UK;Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Birmingham, UK;Department for Health, University of Bath, Bath, UK;Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, B15 2TT, Birmingham, UK;Department of Renal Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK;

关键词: Myeloma;    Acute kidney injury;    Renal impairment;    Serum free light chain;    Patient screening;   

DOI  :  10.1186/s12882-017-0661-z

 received in 2017-04-04, accepted in 2017-07-10,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAcute kidney injury (AKI) is common in patients with multiple myeloma (MM). Whether serum free light chain (sFLC) measurements can distinguish between myeloma and other causes of AKI requires confirmation to guide early treatment. A rapid and portable sFLC test (Seralite®) is newly available and could reduce delays in obtaining sFLC results and accelerate diagnosis in patients with unexplained AKI. This study evaluated the accuracy of Seralite® to identify MM as the cause of AKI.MethodsFLCs were retrospectively analysed in patients with AKI stage 3 as per KDIGO criteria (i.e. serum creatinine ≥354 μmol/L or those on dialysis treatment) (n = 99); 45/99 patients had a confirmed MM diagnosis.ResultsThe Seralite® κ:λ FLC ratio accurately diagnosed all MM patients in the presence of AKI: a range of 0.14–2.02 returned 100% sensitivity and specificity for identifying all non-myeloma related AKI patients. The sFLC difference (dFLC) also demonstrated high sensitivity (91%) and specificity (100%): an optimal cut-off of 399 mg/L distinguished between myeloma and non-myeloma AKI patients. We propose a pathway of patient screening and stratification in unexplained AKI for use of Seralite® in clinical practice, with a κ:λ ratio range of 0.14–2.02 and dFLC 400 mg/L as decision points.ConclusionsSeralite® accurately differentiates between AKI due to MM and AKI due to other causes in patients considered at risk of myeloma. This rapid test can sensitively screen for MM in patients with AKI and help inform early treatment intervention.

【 授权许可】

CC BY   
© The Author(s). 2017