The urine light chain/glomerular filtration rate (GFR) quotient shows a high sensitivity and specificity to detect cast nephropathy in monoclonal light chain disease
| Autor: | Peter Paschka, David Klank, Raoul Bergner, Michael Uppenkamp, Martin Hoffmann |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Urology Renal function Kidney Light chain deposition disease Nephropathy Biopsy medicine AL amyloidosis Humans Immunoglobulin Light-chain Amyloidosis Aged Aged 80 and over Proteinuria medicine.diagnostic_test business.industry Hematology General Medicine Gold standard (test) Middle Aged medicine.disease medicine.anatomical_structure Female Immunoglobulin Light Chains Kidney Diseases medicine.symptom business Multiple Myeloma Glomerular Filtration Rate |
| Zdroj: | European journal of haematologyREFERENCES. 106(6) |
| ISSN: | 1600-0609 |
| Popis: | Background Cast nephropathy (CN) is associated with a unfavourable outcome in monoclonal light chain (mLC) disease, but also more possible LC-related renal diseases as well as non-LC-related disease can occur. Thus, it is crucial to understand the underlying renal disease. On the other hand, LC can interfere with coagulation preventing kidney biopsy as the gold standard. We sought to develop a non-invasive algorithm to diagnose CN with a good sensitivity and specificity. Method We analysed data from patients with mLC disease who underwent kidney biopsy. The patients were classified in 4 groups according the renal histology: CN, AL amyloidosis, light chain deposition disease, and other renal disease. Afterwards, different algorithms were calculated for their sensitivity and specificity. Results CN showed a significant higher concentration of serum-free LC and urine LC (LCu), but there was a wide and overlapping range with the other groups. The best accuracy was achieved for a LCu/GFR ratio >2 in patients with lambda LC and either a LCu/GFR > 1 and proteinuria 5 in patients with proteinuria >8 g/24 h in patients with kappa LC. In lambda LC, the sensitivity and specificity for CN was 94% and 90%, respectively; in kappa LC 87% and 81%, respectively. Discussion In patients with coagulation disturbances due to LC, a non-invasive algorithm can separate patients with CN from other renal disease in mLC disease. |
| Databáze: | OpenAIRE |
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