ABSTRACT
Complement dysregulation from an uncontrolled activation of the alternate pathway can be mediated by C3 Nephritic Factor and results in C3 glomerulopathy. Identification of C3 degradation products C3c and C3d in patient serum provides evidence of uncontrolled complement activation. It is possible to detect C3c and C3d in patient serum by an immunofixation assay which induces in vitro C3 degradation. The clinical performance of the immunofixation assay has been assessed by comparing the assay results with findings from immunostaining of kidney biopsies. The immunofixation assay is a simple and reliable technique for detection of C3 degradation on a widely available platform and can be used to provide corroborative evidence of acquired complement dysregulation in patients with C3 glomerulopathy.
Subject(s)
Complement C3 Nephritic Factor/analysis , Complement C3c/analysis , Complement C3d/analysis , Glomerulonephritis/diagnosis , Immunologic Techniques , Kidney/immunology , Kidney/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Biopsy , Child , Child, Preschool , Complement Activation , Complement Pathway, Alternative , Female , Glomerulonephritis/blood , Glomerulonephritis/immunology , Glomerulonephritis/pathology , Humans , Immunohistochemistry , Infant , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: We investigated how sensitive serum free light chain (FLC) analysis was for the detection of Bence-Jones protein (BJP) and whether a serum kappa/lambda ratio could replace urine electrophoresis as part of the investigation algorithm for monoclonal gammopathy. METHODS: Serum kappa and lambda FLC analysis was performed on 932 consecutive patients investigated for monoclonal gammopathy, along with serum electrophoresis, serum immunofixation where appropriate, and in 483 individuals urine immunofixation. A reference interval for the kappa/lambda ratio was derived from all patients who had normal serum and urine electrophoresis and no B-cell dyscrasia (n = 312). RESULTS: The 100% reference interval was 0.21-1.44 (median 0.50), lower than that previously published. From the 483 patients who provided urines, BJP was detected in 34, with an abnormal kappa/lambda ratio in 26 of these. Using the reference interval, sensitivity, specificity, negative and positive predictive values of an abnormal kappa/lambda ratio for the presence of BJP were 0.76, 0.96, 0.98 and 0.59 respectively. Seven patients had an abnormal kappa/lambda ratio with no paraprotein. CONCLUSION: All kappa/lambda results should be interpreted against a reference interval appropriate for the analyser in use and the population under study. Some urines will be positive for BJP when the serum kappa/lambda ratio is normal, but there is little difference in outcome whether urine for BJP or serum FLC analysis is included in the screening strategy for monoclonal gammopathies. On balance, we believe that it is not yet time to dispense with urine BJP in the investigation of patients with suspected monoclonal gammopathy.