Sánchez-Castañón M, Gago M, Fernandez-Fresnedo G, Gomez-Alamillo C, Ruiz-Criado J, Lopez-Hoyos M, Arias M
Servicio Inmunología, Hospital Universitario Marqués de Valdecilla-IFIMAV, Santander, Spain.
Transplant Proc. 2010 Oct;42(8):2861-3. doi: 10.1016/j.transproceed.2010.08.018.
Plasma cell dyscrasias can cause renal disease. Sensitive methods have recently been introduced to quantify serum free light chains (sFLCs). Renal function may influence the variability of these methods, as shown in chronic kidney disease (CKD) patients, but this problem has not been widely addressed in renal transplant patients. Herein, we examined the association between polyclonal sFLC concentrations and renal function among a population of renal transplant patients. We studied 102 kidney allograft recipients and 53 CKD patients classified according to KDOQI (Kidney Disease Outcomes Quality Initiative) stages. None of them had been diagnosed with monoclonal gammopathy. sFLCs were quantified by nephelometry. Both serum κ and λ free light chain concentrations rose progressively through each stage of KDOQI among both transplant and nontransplant patients (P<.0001). In the former setting, sFLC concentrations significantly correlated, using a Spearman coefficient, with serum creatinine, and serum cystatin concentrations as well as estimated glomerular filtration rate: namely, 0.723, 0.797, and -0.711 for sκFLC and 0.705, 0.759, and -0.694 for sλFLC, respectively (P<.0001 in all cases). Spearman correlation coefficients in nontransplant patients were: 0.559, 0.848, and -0.766 for sκFLC and 0.702, 0.875, and -0.855 for sλFLC, respectively (P<.0001 in all cases). In conclusion, sFLCs must be interpreted cautiously due to their clear association with renal function. Therefore, renal transplantation did not produce changes that were different from those dependent on renal function.
浆细胞异常增生症可导致肾脏疾病。最近已引入敏感方法来定量血清游离轻链（sFLC）。肾功能可能会影响这些方法的变异性，如在慢性肾脏病（CKD）患者中所示，但这个问题在肾移植患者中尚未得到广泛关注。在此，我们研究了肾移植患者群体中多克隆sFLC浓度与肾功能之间的关联。我们研究了102例肾移植受者和53例根据KDOQI（肾脏病预后质量倡议）分期分类的CKD患者。他们均未被诊断出患有单克隆丙种球蛋白病。通过散射比浊法对sFLC进行定量。在移植患者和非移植患者中，血清κ和λ游离轻链浓度在KDOQI的每个阶段均逐渐升高（P<0.0001）。在前一种情况下，使用Spearman系数，sFLC浓度与血清肌酐、血清胱抑素浓度以及估计肾小球滤过率显著相关：即sκFLC分别为0.723、0.797和-0.711，sλFLC分别为0.705、0.759和-0.694（所有情况下P<0.0001）。非移植患者的Spearman相关系数分别为：sκFLC为0.559、0.848和-0.766，sλFLC为0.702、0.875和-0.855（所有情况下P<0.0001）。总之，由于sFLC与肾功能有明确关联，因此必须谨慎解读。因此，肾移植并未产生与依赖肾功能的情况不同的变化。
