From the Research
Elevated lambda IgA is a significant finding that warrants further investigation to determine the underlying cause, with the most recent and highest quality study suggesting that lambda predominance is associated with increased endocapillary hypercellularity in IgA nephropathy, but not with clinical outcomes 1. The finding of elevated lambda IgA may indicate an underlying monoclonal gammopathy, and common conditions associated with this finding include monoclonal gammopathy of undetermined significance (MGUS), multiple myeloma, primary amyloidosis, and certain lymphoproliferative disorders.
- Key considerations in the management of elevated lambda IgA include:
- Complete blood count
- Comprehensive metabolic panel
- Serum protein electrophoresis
- Immunofixation
- Serum free light chain assay
- A hematology-oncology consultation is recommended for proper evaluation and management, as early detection and appropriate management are crucial to prevent progression to more serious diseases requiring prompt intervention. The significance of elevated lambda IgA lies in the abnormal production of immunoglobulins by plasma cells, where the excess lambda light chains paired with IgA heavy chains suggest clonal plasma cell proliferation, and the use of IgA Hevylite (HLC) assays can provide precise quantitative measurements of the monoclonal IgA expression and polyclonal-isotype matched suppression 2. In the context of IgA nephropathy, the increased anionic IgA lambda may be important in determining its selective mesangial binding, which could contribute to the immunopathogenesis of the disease 3. However, the relationship between elevated lambda IgA and clinical outcomes is not well established, and further studies are needed to determine the prognostic value of this finding 1.