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The Influence of Renal Function Impairment on Kappa Free Light Chains in Cerebrospinal Fluid

Franz F Konen1, Philipp Schwenkenbecher1, Ulrich Wurster1

  • 1Department of Neurology, Hannover Medical School, Hannover, Germany.

Journal of Central Nervous System Disease
|November 29, 2021
PubMed

Insights

Renal function impacts kappa free light chain (KFLC) measurements in cerebrospinal fluid (CSF). Quotient diagrams are more reliable than KFLC index for interpreting KFLC in neuroinflammatory diseases.

Area of Science:

  • Neurology
  • Clinical Chemistry
  • Immunology

Background:

  • Kappa free light chains (KFLC) in cerebrospinal fluid (CSF) are emerging biomarkers for detecting intrathecal immunoglobulin synthesis.
  • Renal function impairment can alter serum KFLC and albumin, potentially affecting CSF KFLC interpretation.

Purpose of the Study:

  • To investigate the influence of renal function on KFLC and albumin concentrations in CSF.
  • To compare the reliability of KFLC index versus quotient diagrams for interpreting KFLC in various CSF profiles.

Main Methods:

  • A two-center study analyzed KFLC and albumin in patients with physiological, non-inflammatory, and inflammatory CSF profiles.
  • Renal function was assessed using the CKD-EPI creatinine equation.
  • KFLC index and KFLC in quotient diagrams (KFLC IF) were evaluated against hyperbolic reference ranges.

Main Results:

  • Declining KFLC indices and KFLC IF values correlated with decreased renal function across all sample groups (P < .0209).
  • In inflammatory CSF profiles, 15% of patients had a low KFLC index and 10% had a low intrathecal KFLC fraction, indicating potential false negatives.
  • Quotient diagram interpretation showed less susceptibility to renal impairment compared to the KFLC index.

Conclusions:

  • Renal function must be considered when interpreting KFLC results in neuroinflammatory diseases.
  • KFLC interpretation using quotient diagrams is preferred over the KFLC index due to its lower susceptibility to renal function impairment.
Abstract

Keywords:
biomarkercerebrospinal fluideGFRkappa free light chains (KFLC)reiber’s diagramrenal function

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