Bence Jones Proteins - Qualitative

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Typically produced in excess by abnormal plasma cells in disorders such as multiple myeloma

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Bence Jones Proteins - Qualitative Test Information Guide

Why is it done?
- This test detects the presence of Bence Jones proteins (light chains) in urine, which are small immunoglobulin fragments produced abnormally by plasma cells
- Screening and diagnosis of multiple myeloma and other plasma cell dyscrasias, including light chain disease and Waldenström macroglobulinemia
- Monitoring patients with known monoclonal gammopathy or myeloma to assess disease progression or response to treatment
- Investigating unexplained kidney damage (acute kidney injury or chronic kidney disease) that may be caused by light chain deposition or cast nephropathy
- Evaluating patients with unexplained proteinuria, anemia, hypercalcemia, or bone pain
- Typically performed when clinical suspicion for plasma cell malignancy exists or as part of routine screening in symptomatic patients
Normal Range
- Normal Result: Negative or Not Detected - No Bence Jones proteins present in urine
- Abnormal Result: Positive - Bence Jones proteins detected in urine (qualitative test; presence/absence reported)
- Units of Measurement: Qualitative (positive/negative); quantitative urine protein electrophoresis can measure specific levels (mg/24 hours or g/24 hours)
- Interpretation: Negative results are reassuring and normal; positive results indicate abnormal light chain production and require further investigation; trace amounts may require repeat testing for confirmation
Interpretation
- Positive Result Significance: Indicates monoclonal light chain protein in urine; suggests multiple myeloma (most common), light chain disease, Waldenström macroglobulinemia, systemic light chain amyloidosis, or other plasma cell dyscrasias
- Negative Result Significance: Absence of monoclonal light chains; makes plasma cell malignancy less likely, though some patients with myeloma may have serum-only disease without urinary light chains
- Factors Affecting Results: Urine concentration and pH affect detection; dehydration increases concentration (may cause false positive); excessive hydration may dilute results; improper sample collection or storage may affect accuracy; certain medications and inflammatory conditions may cause transient proteinuria; age and kidney function influence results
- Clinical Correlation: Results must be correlated with clinical symptoms, serum electrophoresis, immunofixation, complete blood count, calcium levels, and renal function; positive results warrant comprehensive evaluation for malignancy; negative results in symptomatic patients should prompt repeat testing or alternative diagnostic approaches; quantitative measurement via 24-hour urine collection provides more precise assessment
- Clinical Significance: Critical for diagnosis of multiple myeloma and light chain diseases; important for monitoring disease progression and treatment response; helps predict kidney involvement and risk of myeloma cast nephropathy; may indicate need for urgent intervention to prevent renal complications
Associated Organs
- Primary Organ Systems: Bone marrow (site of plasma cell proliferation), kidneys (primary organ affected by light chain excretion), urinary system
- Conditions Associated with Abnormal Results: Multiple myeloma, light chain myeloma, light chain disease, Waldenström macroglobulinemia, systemic light chain amyloidosis (AL amyloidosis), primary systemic amyloidosis, monoclonal gammopathy of undetermined significance (MGUS), light chain deposition disease, immunoglobulin D (IgD) myeloma, immunoglobulin E (IgE) myeloma
- Kidney-Related Complications: Myeloma kidney (cast nephropathy) - acute kidney injury or chronic kidney disease caused by light chain casts obstructing renal tubules, light chain deposition disease causing glomerulonephritis, light chain-associated amyloidosis affecting glomeruli and interstitium, acute tubular necrosis, tubulointerstitial damage
- Extrarenal Manifestations: Bone disease (osteolytic lesions, osteoporosis), anemia, hypercalcemia, infections, neuropathy, cardiac involvement (amyloidosis), hepatomegaly, splenomegaly
- Potential Complications: End-stage renal disease requiring dialysis, progressive kidney failure, electrolyte imbalances, fluid overload, rapid disease progression if left untreated, risk of sudden death in cardiac amyloidosis, pathological fractures, severe anemia requiring transfusion
Follow-up Tests
- Initial Confirmatory Tests: Serum protein electrophoresis, serum immunofixation electrophoresis, 24-hour urine protein electrophoresis and immunofixation, serum immunoglobulin levels (IgG, IgA, IgM), serum free light chains assay (most sensitive test for light chain disease)
- Diagnostic and Staging Tests: Bone marrow biopsy with flow cytometry, cytogenetics (FISH analysis), fluorodeoxyglucose positron emission tomography (FDG-PET), magnetic resonance imaging (MRI) of spine and pelvis, complete blood count (CBC), comprehensive metabolic panel, serum calcium, serum beta-2 microglobulin, serum lactate dehydrogenase (LDH)
- Renal Assessment Tests: Serum creatinine, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), urinalysis with microscopy, 24-hour urine protein quantification, kidney biopsy with light microscopy, immunofluorescence, and electron microscopy (if needed), serum phosphorus, serum albumin
- Monitoring During Treatment: Repeat serum and urine protein electrophoresis/immunofixation, serum free light chains (most frequent monitoring - every 2-4 weeks during treatment), complete blood count, comprehensive metabolic panel with renal function assessment, 24-hour urine Bence Jones protein quantification (every 3-6 months), bone marrow studies (as clinically indicated)
- Monitoring Frequency: Newly diagnosed: Monthly or bi-monthly during treatment; Stable disease: Every 3-6 months; Remission: Every 6-12 months; Relapse surveillance: Escalate frequency based on clinical status; Post-treatment: Long-term follow-up annually or as clinically indicated
- Specialty Testing: Amyloid typing (if amyloidosis suspected - Congo red staining, electron microscopy, mass spectrometry), cardiac biomarkers (troponin, N-terminal pro-B-type natriuretic peptide [NT-proBNP]), peripheral neuropathy assessment, vitamin B12 and folate levels
Fasting Required?
- Fasting Requirement: No - Fasting is NOT required for Bence Jones Proteins qualitative urinalysis test
- Sample Collection Guidelines: Random urine sample or preferably first morning urine (more concentrated) is acceptable; if quantitative measurement is needed, a 24-hour urine collection is required
- Patient Preparation: No special preparation required; maintain normal diet and hydration; collect midstream clean-catch urine sample in a sterile container; for 24-hour collection, start collection in morning after first void (discard that sample), collect all urine for 24 hours into provided container, store refrigerated if testing cannot be performed immediately
- Medications: No medications need to be avoided; continue all regular medications unless specifically instructed otherwise by physician; some chemotherapy agents used to treat myeloma may affect light chain levels, but this is expected and monitored as part of disease assessment
- Special Instructions: Inform laboratory of current medications, recent infections, or fever; if collecting 24-hour specimen, note start and end times precisely; avoid contamination of sample; deliver sample to laboratory promptly (within 2 hours if possible); if dehydrated, indicate to provider as this may affect results; for women, avoid collecting sample during menstruation if possible; samples older than 4 hours at room temperature may show decreased sensitivity

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