cast nephropathy: practical considerations in the management of myeloma kidney-what we know and what the future may hold.
"In the presence of green tea, the chains have a different internal structure, as the ECGC pulled the light chain
into a different type of aggregate that wasn't toxic and didn't form fibril structures," as happens to organs affected by amyloidosis," " Bieschke explained.
Urine studies are still widely used in the detection and assessment of free light chain
disease, although recent studies support the value of sFLC assays over urine studies in many circumstances.
Wechalekar, "Update on treatment of light chain
amyloidosis," Haematologica, vol.
Caption: Figure 5: Percentage of the main myofibrillar proteins from beef, lamb, and chicken samples extracted with denaturing and nondenaturing solutions (D = denaturing; ND = nondenaturing; MHC = myosin heavy chain; a-act = [alpha]-actinin; TnT = troponin T; TPM = tropomyosin; MLC1 = myosin light chain
1; MLC2 = myosin light chain
2; *P < 0.05; **P < 0.01; ***P < 0.001) (means [+ or -] SEM).
Although bone marrow puncture was not performed in our case, no abnormalities in protein electrophoresis of serum and urine or the serum free light chain
ratio were observed; therefore, the involvement of myeloproliferative diseases was excluded.
Treatment of light chain
(AL) amyloidosis with the combination of bortezomib and dexamethasone.
An educated and proactive lab director may know that SPEP is only 80 percent to 88 percent sensitive, and that the guidelines recommend ordering SPEP, a free light chain
test, and serum immunofixation.
A unique aspect of this case, in our opinion, was the absence of measurable monoclonal IgM on SPEP but a detectable monoclonal IgM band on serum immunofixation along with elevated serum free kappa light chains
(currently not a component of NCCN Guidelines for diagnosis or management of LPL/WM).
The urine dipstick is specific for albumin and will miss positively charged proteins in the urine, such as immunoglobulin light chains
.  The bedside detection of non-albumin proteinuria is aided by the use of a simple, inexpensive and often-overlooked investigation: addition of SSA 3% to urine.
The IMMUNOFIX[R] kit (The Binding Site, Birmingham, UK) was used to detect and identify the immunoglobulins and their light chains
in solubilized cryoglobulins and to evaluate the presence of monoclonal immunoglobulins in this material.
Serum free light chains
gave us a clue to the diagnosis in this case.