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General questions and discussion about multiple myeloma (i.e., symptoms, lab results, news, etc.) If unsure where to post, use this discussion area.

How important is 24 hour urine test?

by Babs on Fri Oct 04, 2013 12:46 pm

I see comments here about 24 hour urine testing .My spouse's hematologist has never requested urine samples and tracks his myeloma with bloodwork /skeletal surveys etc. Is urine testing only used for certain types of myeloma?


Re: How important is 24 hour urine test?

by kjpoppit on Fri Oct 04, 2013 1:56 pm

In my case, the test did not help. It's all in the blood for me. I know there is a difference in this test and is important to others. I am new to this myeloma deal and I am sure someone else will be able to explain it.

Name: Kim Nelson
Who do you know with myeloma?: Me
When were you/they diagnosed?: Sept. 19th, 2013
Age at diagnosis: 47

Re: How important is 24 hour urine test?

by Amelia on Fri Oct 04, 2013 9:36 pm

Babs, I was diagnosed in December 2011 in remission for a year. I do a 24hr urine test every 6 weeks and weekly blood test. Blood test detect Monoclonal proteins (M proteins) also known as M spike, parts of M protein may also be detected in the urine. Multiple myeloma was 80% of my body so it was in my blood & urine. Since being diagnosed I do a lot of reading and research I found for me being your own advocate is a good thing.

Name: Amelia
Who do you know with myeloma?: Self
When were you/they diagnosed?: December 2011
Age at diagnosis: 52

Re: How important is 24 hour urine test?

by Wayne K on Sat Oct 05, 2013 11:39 am

It's the most important for me. I have Bence Jones and the light chain output tells a lot about my disease. There are other indicators, but if I understand it right, the 24 hr urine test is just under the biopsy for me.

Wayne K
Name: Wayne
Who do you know with myeloma?: Myself, my sister who passed in '95
When were you/they diagnosed?: 03/09
Age at diagnosis: 70

Re: How important is 24 hour urine test?

by Karen on Sat Oct 12, 2013 11:49 am

I was in a clinical trial and the 24-hour-urine test was required for me once a month - very annoying :-) Finally my doctor figured out a way to get around that and I was able to do it every couple of months, then every 3-4 months. In my case, the results were always the same - basically nothing turned up except a "faint band." The doctor said that it really wasn't very helpful in my case in determining if the disease was progressing - for me it seems to be all about the Kappa light chains.

Name: Karen
When were you/they diagnosed?: December 2010
Age at diagnosis: 51

Re: How important is 24 hour urine test?

by Dr. Peter Voorhees on Sun Oct 13, 2013 2:55 pm

Dear Babs,

The 24 hour urine protein electrophoresis and immunofixation are most useful for those who have "free light chain" myeloma. In other words, their myeloma cells are either making a lot of free kappa light chain antibodies or free lambda light chain antibodies that are not complexed to a heavy chain (IgG, IgA, IgM, IgD, IgE). A patient's myeloma may make free light chain antibodies exclusively, none or hardly any at all, or a combination of intact antibodies (e.g. IgG kappa) and free light chains (e.g. free kappa light chains).

Free kappa and lambda light chains antibodies are not easily picked up by serum protein electrophoresis (at least not until they reach high levels). The 24 hour urine is much better at picking these up.

The serum free light chain test can also be used to measure free kappa and lambda light chain anibody levels and is even more sensitive than the 24-hour urine testing. The serum free light chain testing has allowed us to rely less heavily on the 24 hour urine tests for those with free light chain myeloma. It may be that your doctor is using this test in the place of the urine testing.

Even if your myeloma does not have a significant free light chain component (i.e. is not making much free kappa or lambda light chain antibodies), your physician should "spot check" the serum free light chain test periodically to assess for free light chain escape. This is a phenomenon in which a myeloma stops making an intact antibody and starts producing just the free light chain component of the antibody. For example, an IgG kappa myeloma may evolve into a free kappa light chain myeloma if the IgG portion of the antibody is no longer made. An SPEP alone would not pick this up until late in the game.

I hope this helps. Let me know if you have any other questions.

Take care!

Pete V.
Dr. Peter Voorhees
University of North Carolina at Chapel Hill

Any advice provided in these postings is based on a very limited amount of information. There is no substitute for the care of your oncologist/hematologist. Therefore, all suggestions should be discussed with your treating physician. None of the comments presented here are meant to replace the evaluation of a patient by a knowledgeable physician.

Dr. Peter Voorhees
Name: Peter Voorhees, M.D.
Beacon Medical Advisor

Re: How important is 24 hour urine test?

by Anonymous on Thu Oct 17, 2013 5:37 pm

I have done a monthly urine since being diagnosed in 2005. I have no M spike and my urine protein # is a secondary indicator to my serum protein. I exhibit urine protein only when the serum protein becomes elevated. In my most recent blood work, also monthly, my urine protein dropped 50%, a positive indicator, while my serum protein dropped less than that %. I am on my second round of Pomalyst which appears to be working and will see how numbers look at end of this round.


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