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Impact of Renal Function on Serum Free Light Chain Interpretation: A Comprehensive Review and Call for Stratified
Sushant Dhanavade1, Anshuli Vispute2
1Department of Biochemistry, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, IND.
Abstract:
The serum free light chain (FLC) assay has transformed the diagnosis and monitoring of plasma cell dyscrasias, yet its interpretation is significantly complicated by renal impairment. This comprehensive review, synthesizing evidence from 24 studies identified through a systematic search of PubMed, Scopus, and Web of Science (from inception to September 2023), examines the relationship between renal function and FLC metabolism, evaluates limitations in current reference interval application, and proposes strategies for improving diagnostic accuracy through renal function-stratified interpretation. The literature consistently demonstrates a strong inverse correlation between estimated glomerular filtration rate (eGFR) and serum FLC concentrations. Current manufacturer-derived reference intervals, established in young, healthy populations, lead to high false-positive rates in elderly patients with renal impairment, triggering unnecessary investigations. Studies proposing adjusted thresholds demonstrate significant potential for reducing false-positive interpretations without compromising sensitivity for detecting true monoclonal gammopathies. We advocate for the widespread adoption of eGFR-stratified reference intervals to reduce unnecessary investigations, decrease healthcare costs, and improve patient care.
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