From the Research
A patient with elevated kappa (κ) light chains and hematuria should be referred to a hematologist promptly, as these findings suggest a possible plasma cell disorder, particularly multiple myeloma or light chain amyloidosis, which can lead to significant morbidity and mortality if left untreated 1. When considering referral, it is essential to evaluate the kappa/lambda ratio, as an abnormal ratio (>1.65) is a critical indicator of a potential plasma cell disorder 2. The presence of hematuria in conjunction with elevated kappa light chains is particularly concerning, as it may indicate kidney damage from light chain deposition or cast nephropathy, which can lead to chronic kidney disease or end-stage renal disease if not addressed promptly 3.
Key considerations for referral include:
- Abnormal kappa/lambda ratio (>1.65)
- Presence of hematuria
- Unexplained anemia, hypercalcemia, renal dysfunction, or bone pain
- Elevated serum free light chains
While awaiting hematology consultation, additional testing should be considered, including:
- Serum and urine protein electrophoresis
- Complete blood count
- Comprehensive metabolic panel
- Skeletal survey or low-dose CT scan to evaluate for bone lesions
Early referral is crucial, as prompt diagnosis and treatment of plasma cell disorders can prevent irreversible organ damage, particularly to the kidneys 4. The hematologist will determine if a bone marrow biopsy is needed to confirm the diagnosis and will guide appropriate therapy, which may include chemotherapy, immunomodulatory drugs, proteasome inhibitors, or stem cell transplantation depending on the specific diagnosis and patient factors 5.