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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2017: 3.556

CiteScore 2017: 2.34

SCImago Journal Rank (SJR) 2017: 1.114
Source Normalized Impact per Paper (SNIP) 2017: 1.188

Online
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1437-4331
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Volume 54, Issue 6

Issues

Comparison of Freelite™ and N Latex serum free light chain assays in subjects with end stage kidney disease on haemodialysis

Alice Kennard / Carmel Hawley
  • Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia
  • School of Medicine, University of Queensland, Brisbane, QLD, Australia
  • Translational Research Institute, Brisbane, QLD, Australia
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/ Jill Tate
  • Chemical Pathology Department, Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
  • Other articles by this author:
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/ Sandra Klingberg
  • Chemical Pathology Department, Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
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/ Carel Pretorius
  • Chemical Pathology Department, Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
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/ Colin Hutchison / Peter Mollee
  • Corresponding author
  • Department of Haematology, Pathology Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld 4102, Australia
  • Email
  • Other articles by this author:
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Published Online: 2015-12-18 | DOI: https://doi.org/10.1515/cclm-2015-0799

Abstract

Background: Quantification of serum free light chains (FLC) is important in the diagnosis of plasma cell diseases where an abnormal kappa:lambda ratio infers a population of monoclonal plasma cells. The Freelite™ and N Latex assays have been validated in populations without kidney disease but there is a paucity of data relating to the use of these assays in end stage kidney disease (ESKD). The aim of the study was to compare FLC assay performance in ESKD patients on haemodialysis.

Methods: Cross-sectional multi-centre study comparing the performance of the two assays on 112 haemodialysis patients without known paraproteinaemia. We quantified FLC pre- and post-dialysis using both the N Latex and the Freelite assays.

Results: FLC levels were elevated by both assays. Lambda FLC levels were considerably higher by the N Latex assay. Using the proposed renal reference range for Freelite (0.37–3.1) all but one patient had normal kappa:lambda FLC ratios. In contrast, there were no abnormal FLC ratios pre-dialysis using the N Latex assay. This was due to lambda FLC reading significantly higher by the N Latex assay. Kappa and lambda FLC levels decreased with dialysis but remained elevated above the normal range. The excess of lambda FLC by N Latex persisted post-dialysis but was somewhat attenuated. Dialysis adequacy and dialysis modality predicted clearance of kappa and lambda FLC by both assays.

Conclusions: The N Latex assay reported significantly higher pre-dialysis lambda FLC concentrations compared with the Freelite assays. Clinicians should be aware of the need for a separate renal reference range for interpreting FLC ratio using the Freelite assay but not for the N Latex assay in ESKD patients.

This article offers supplementary material which is provided at the end of the article.

Keywords: end stage kidney disease (ESKD); free light chain; Freelite; haemodialysis; kappa; lambda; light chain assay; N Latex; renal failure

References

  • 1.

    Bradwell, AR, editor. Serum free light chain analysis, 5th ed. Birmingham: The Binding Site Ltd, 2008:167–73.Google Scholar

  • 2.

    Abraham RS, Katzmann JA, Clark RJ, Bradwell AR, Kyle RA, Gertz MA. Quantitative analysis of serum free light chains. A new marker for the diagnostic evaluation of primary systemic amyloidosis. Am J Clin Pathol 2003;119:274–8.Google Scholar

  • 3.

    Drayson M, Tang LX, Drew R, Mead GP, Carr-Smith H, Bradwell AR. Serum free light-chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma. Blood 2001;97:2900–2.Google Scholar

  • 4.

    Dispenzieri A, Kyle R, Merlini G, Miguel JS, Ludwig H, Hajek R, et al. International Myeloma Working Group. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia 2009;23:215–24.Web of ScienceGoogle Scholar

  • 5.

    Hoedemakers RM, Pruijt JF, Hol S, Teunissen E, Martens H, Stam P, et al. Clinical comparison of new monoclonal antibody-based nephelometric assays for free light chain kappa and lambda to polyclonal antibody-based assays and immunofixation electrophoresis. Clin Chem Lab Med 2011:50:489–95.Google Scholar

  • 6.

    Hutchison CA, Plant T, Drayson M, Cockwell P, Kountouri M, Basnayake K, et al. Serum free light chain measurement aids the diagnosis of myeloma in patients with severe renal failure. BMC Nephrol 2008;9:11.Google Scholar

  • 7.

    Hutchison CA, Harding S, Hewins P, Mead GP, Townsend J, Bradwell AR, et al. Quantitative assessment of serum and urinary polyclonal free light chains in patients with chronic kidney disease. Clin J Am Soc Nephrol 2008;3:1684–90.Google Scholar

  • 8.

    Jacobs JF, Hoedemakers RM, Teunissen E, Te Velthuis H. N Latex FLC serum free light-chain assays in patients with renal impairment. Clin Chem Lab Med 2014;52:853–9.Google Scholar

  • 9.

    Tate J, Bazeley S, Klinberg S, Pretorius CJ, Hawley C, Mollee P. Comparison of the Freelite and N Latex srum free light chain (FLC) assays in chronic kidney disease [abstract]. Clin Biochem Rev 2012;33:S41.Google Scholar

  • 10.

    Data from manufacturer’s dialyser data sheets. www.fmc-ag.com, www.nipro.com, www.baxter.com.

  • 11.

    Jenner W, Klingberg S, Tate JR, Wilgen U, Ungerer JP, Pretorius CJ. Combined light chain immunofixation to detect monoclonal gammopathy: a comparison to standard electrophoresis in serum and urine. Clin Chem Lab Med 2014;52:981–7.Web of ScienceGoogle Scholar

  • 12.

    MedCalc for Windows v. 15.2.2 (2015). www.medcalc.org.

  • 13.

    Lavatelli F, Brambilla F, Valentini V, Rognoni P, Casarini S, Di Silvestre D, et al. A novel approach for the purification and proteomic analysis of pathogenic immunoglobulin free light chains from serum. Biochim Biophys Acta 2011;1814:409–19.Google Scholar

  • 14.

    Hutchison CA, Cockwell P, Reid S, Chandler K, Mead GP, Harrison J, et al. Efficient removal of immunoglobulin free light chains by hemodialysis for multiple myeloma: in vitro and in vivo studies. Clin J Am Soc Nephrol 2007;18:886–95.Google Scholar

  • 15.

    Hutchison CA, Basnayake K, Cockwell P. Serum free light chain assessment in monoclonal gammopathy and kidney disease. Nat Rev Nephrol 2009;11:621–8.Web of ScienceGoogle Scholar

  • 16.

    Berlanga O, Carr-Smith H, Harding S. Response to Jacobs: N Latex FLC serum free light-chain assays in patients with renal impairment. Clin Chem Lab Med 2014;52:e243–5.Google Scholar

About the article

Corresponding author: Dr. Peter Mollee, Department of Haematology, Pathology Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld 4102, Australia, Phone: +61 7 3176 5080, Fax: +61 7 3176 5480


Received: 2015-08-19

Accepted: 2015-11-09

Published Online: 2015-12-18

Published in Print: 2016-06-01


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 54, Issue 6, Pages 1045–1052, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2015-0799.

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