title: Quantitative assessment of serum and urinary polyclonal free light chains in patients with type II diabetes: an early marker of diabetic kidney disease?
abstract: OBJECTIVE
  Free light chains (FLCs) are bi-products of normal immunoglobulin synthesis and are predominately removed from the circulation by the kidneys. This study assessed polyclonal FLCs as a novel biomarker of early diabetic kidney disease.
  
  
  METHODS
  Serum and urinary FLCs were assessed by the immunoassay Freelite, in white and South-Asian patients with type II diabetes recruited from the United Kingdom Asian Diabetes Study.
  
  
  RESULTS
  The incidence of monoclonal proteins in this diabetic population was 1.9%. Type II diabetic patients had significantly raised concentrations of serum polyclonal FLCs before overt renal impairment developed (p < 0.001). Both kappa and lambda FLCs correlated with all tested markers of renal function; in particular cystatin-C: Spearman's coefficient (R) = 0.55 (p < 0.01) and R = 0.56 (p < 0.01), respectively. The South-Asian diabetic patients had higher serum polyclonal FLCs than Caucasian diabetic patients and this was independent of renal function. Urinary FLCs concentrations were raised in diabetic patients (p < 0.001). The majority (68%) of diabetic patients with normal urinary albumin:creatinine ratios (ACRs) had abnormal urinary FLC:creatinine ratios. Both kappa and lambda FLC concentrations correlated with urinary ACR: R = 0.32, p < 0.01 and R = 0.25, p < 0.01 respectively.
  
  
  CONCLUSIONS
  Type II diabetic patients can have significantly raised concentrations of serum and urinary polyclonal FLCs before overt renal disease occurs. These novel findings provide the basis for future studies to assess whether polyclonal FLCs could provide a useful tool for early diagnosis of diabetic kidney disease.
authors.affiliation: Queen Elizabeth Hospital, Department of Renal Medicine, QEMC, Birmingham, B15 2TH, UK. CAH692@bham.ac.uk
authors.forename: Colin A
authors.initials: CA
authors.lastname: Hutchison
authors.forename: Paul
authors.initials: P
authors.lastname: Cockwell
authors.forename: Steven
authors.initials: S
authors.lastname: Harding
authors.forename: Graham P
authors.initials: GP
authors.lastname: Mead
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Bradwell
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Barnett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000652:urine; D003928:Diabetic Nephropathies / Q000097:blood* / Q000652:urine*; D005260:Female; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000097:blood* / Q000652:urine*; D008297:Male; D008875:Middle Aged; D044465:White People
chemical_list: D015415:Biomarkers; D007147:Immunoglobulin Light Chains