Κ and Λ Urine Free Light Chains: a New Method for Quantification

Background: Immunofixation electrophoresis of urinary proteins, coupled with densitometric analysis, is the gold standard method for determining urinary monoclonal free light chains (FLCs), i.e. Bence Jones protein. Recently, immunochemical methods have been developed for Bence Jones protein quantification, but no such method has been widely adopted. This study evaluated a new antibody-based immunoturbidimetry method for urinary FLC quantification, using immunofixation electrophoresis as reference. Methods: kappa and lambda FLCs were measured in urine specimens from 95 (training cohort) and 103 (testing cohort) patients by both immunofixation electrophoresis and immunoturbidimetry. Results: There was almost perfect concordance in the training cohort between the new immunoturbidimetry assay and immunofixation electrophoresis and substantial agreement, with Cohen kappa of 0.85 and 0.75, for kappa and lambda FLC determination, respectively. Results were confirmed in the testing cohort, where Cohen kappa was 0.86 for kappa and 0.94 for lambda FLCs. The kappa FLC assay had 88% sensitivity and 98%-100% specificity; the lambda FLC assay had 94% and 96% sensitivity and 91% and 99% specificity in the training and testing cohorts, respectively. Conclusions: The new immunochemical method has a satisfactory performance and almost perfect agreement with immunofixation electrophoresis and gives the advantage of FLC quantification.