High Kappa Immunoglobulin Levels: Potential Health Risks

Elevated levels of immunoglobulin Kappa?

Hello, I am a 48-year-old male, 166 cm tall and weighing 66 kg, with hereditary Mediterranean anemia.
I had a urinary stone in 2012, but it passed naturally.
I do not have hypertension (January 2018 readings: 122 mmHg systolic, 77 mmHg diastolic) or hyperglycemia (fasting blood glucose levels in 2017 ranged from 84 to 94 mg/dL).
Occasionally, I have hyperlipidemia, but my lipid levels have decreased with medication (total cholesterol levels in 2017 were: 221, 198, 209, 175, and 170 mg/dL).
Prior to January 2018, all my health check-ups showed no signs of hematuria.
I have mild fatty liver, do not consume alcohol, and have not smoked for five years.

Since August 2017, I have been monitoring my kidney function due to elevated serum creatinine levels.
The relevant lab results are as follows: in August 2017, a kidney ultrasound showed no abnormalities; in September 2017, a 24-hour urine collection calculated an estimated glomerular filtration rate (eGFR) of 74.17.
The doctor considered this within an acceptable range, so I continued to be monitored.
However, in January 2018, blood tests revealed serum immunoglobulin levels: Kappa = 197.07 mg/L, Lambda = 14.46 mg/L, and a Kappa/Lambda ratio of 13.63.
The doctor indicated that the Kappa value was approximately ten times higher than normal, which is concerning and requires kidney and bone marrow biopsies to determine the underlying cause.
I felt overwhelmed and unsure of what questions to ask the doctor.
After researching online, I discovered that abnormal Kappa immunoglobulin levels could indicate multiple myeloma, which heightened my anxiety.

Therefore, I would like to ask if a Kappa value that is approximately ten times higher than normal could indicate multiple myeloma, or could it also be related to some form of kidney disease? Is it truly necessary to perform kidney and bone marrow biopsies to identify the cause? Thank you!
Blood Urea Nitrogen:
April 2017: 15 mg/dL
July 2017: 14 mg/dL
August 2017: 15.9 mg/dL
August 2017: 13.4 mg/dL
September 2017: 17.9 mg/dL
October 2017: 15 mg/dL
November 2017: 12.1 mg/dL
January 2018: 12.9 mg/dL
Serum Creatinine:
March 2016: 1.22 mg/dL
March 2017: 1.26 mg/dL
April 2017: 1.27 mg/dL
July 2017: 1.42 mg/dL (eGFR: 56.798)
August 2017: 1.55 mg/dL (eGFR: 51.337)
August 2017: 1.49 mg/dL (eGFR: 50)
September 2017: 1.53 mg/dL (eGFR: 49) (but the 24-hour urine collection calculated by the doctor was 74.17)
October 2017: 1.46 mg/dL (eGFR: 55.006)
November 2017: 1.38 mg/dL (eGFR: 55)
January 2018: 1.39 mg/dL (eGFR: 55)
Urine Microalbumin/Creatinine:
August 2017: 225.1 mg/g
September 2017: 187.7 mg/g (24-hour urine collection, total urine volume 2950 mL)
November 2017: 247.7 mg/g
January 2018: 303.4 mg/g
Proteinuria:
March 2016: -
March 2017: +/-
July 2017: 55.8 mg/dL
August 2017: -
August 2017: -
September 2017: 1+ (30 mg/dL)
October 2017: + (56.590 mg/dL)
November 2017: -
January 2018: -
Serum Immunofixation Electrophoresis Analysis:
November 2017 test results: IFE paraproteins of IgG-kappa and more: free kappa light chain more: categories are identified.

Asahi, 40~49 year old female. Ask Date: 2018/01/18

Dr. Wu Jiyu reply Internal Medicine

Based on your inquiry, I can provide you with some recommendations: 1.
The eGFR of 55 is slightly low, and the urine microalbumin/creatinine ratio of 303.4 mg/g is elevated; it is advisable to have long-term follow-up with a nephrologist.
2.
Regarding the immunoglobulin levels, Kappa = 197.07 mg/L, Lambda = 14.46 mg/L, and the Kappa/Lambda ratio of 13.63, it is recommended to refer you to a hematology-oncology specialist for further evaluation, as a single data point cannot determine the specific disease.
Thank you for your inquiry; the Nephrology Department of Changhua Hospital is concerned about your health.

Reply Date: 2018/01/18

More Info

High levels of Kappa immunoglobulin can indeed raise concerns about potential health issues, particularly regarding plasma cell disorders such as multiple myeloma. In your case, the significantly elevated Kappa levels (197.07 mg/L) compared to the Lambda levels (14.46 mg/L) and the Kappa/Lambda ratio (13.63) suggest an imbalance that warrants further investigation.

Multiple myeloma is a type of blood cancer that arises from plasma cells, which are a type of white blood cell responsible for producing antibodies. In this condition, abnormal plasma cells proliferate and produce excessive amounts of a single type of immunoglobulin, leading to elevated levels of either Kappa or Lambda light chains. The presence of a high Kappa/Lambda ratio is often indicative of a monoclonal gammopathy, which can be a precursor to multiple myeloma or other related conditions.

However, it is essential to note that elevated Kappa levels are not exclusively indicative of multiple myeloma. Other conditions can also lead to increased Kappa light chains, including:
1. Monoclonal Gammopathy of Undetermined Significance (MGUS): This is a benign condition where there is an abnormal increase in monoclonal proteins without the symptoms or organ damage associated with multiple myeloma. MGUS can progress to multiple myeloma in some cases, but many individuals remain stable for years.

2. Chronic Inflammatory Conditions: Conditions such as rheumatoid arthritis or chronic infections can lead to increased immunoglobulin production, resulting in elevated Kappa levels.

3. Kidney Disease: Certain kidney diseases can affect the clearance of light chains from the bloodstream, leading to elevated levels. Your history of elevated creatinine and microalbuminuria suggests that kidney function should be closely monitored.

4. Other Plasma Cell Disorders: Conditions like Waldenström's macroglobulinemia or light chain amyloidosis can also present with abnormal immunoglobulin levels.

Given your medical history and the current lab findings, it is prudent to follow your physician's recommendation for further testing, including kidney and bone marrow biopsies. These tests will provide more definitive information regarding the nature of the abnormal Kappa levels and whether there is an underlying malignancy or another condition at play.

In terms of your health management, it is crucial to maintain regular follow-ups with your healthcare provider. They can help monitor your kidney function and any potential progression of your condition. Additionally, lifestyle modifications such as maintaining a balanced diet, staying hydrated, and managing any other health conditions (like high cholesterol) can support your overall health.

In conclusion, while high Kappa immunoglobulin levels can be concerning and may suggest multiple myeloma or other plasma cell disorders, they are not definitive on their own. Comprehensive evaluation and monitoring are essential to determine the underlying cause and appropriate management. Always feel free to ask your healthcare provider any questions or express concerns you may have regarding your health and test results.

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