Bence Jones Protein (BJP), Urine Free Light Chains, BJP (24 hour excretion)

Immunology

---

Description

Immunoglobulins are made up of two identical heavy chains and two identical light chains, bound together by disulphide bonds. Free light chains ( kappa and/or lambda ) can be found in both the serum and urine. The concentration of free light chains increase in hyperimmunoglobulinaemic states [1]. Overflow proteinuria occurs when increased serum levels of proteins of low molecular mass are filtered through the glomerulus and exceed the reabsorptive capacity of the tubules. Bence Jones protein ( BJP ) is the name given to the presence of monoclonal free light chains in the urine [4]. Renal impairment occurs frequently in myeloma, occuring in up to 50% of patients at some stage of the illness. Patients with BJP are particularly susceptable to this [2]. BJP is associated with multiple myeloma, Waldenstroms macroglobulinaemia, monoclonal light chain associated amyloidosis and light chain deposition disease. It can also be seen in lymphoma and leukaemia [3]. Guidelines for the analysis of BJP suggest that the test is useful when myeloma is diagnosed and during its follow-up, and in the investigation of patients who have suspected monoclonal gammopathy. The recommended method for BJP investigation is by electrophoresis of urine and the type confirmed by immunofixation [3]. Urine total protein ( albumin ) and densitometry are used to aid in the quantitation of the free light chain.

---

Indications

An estimation of the excretion of free light chains in urine. Indicative of Bence Jones Proteinuria.

---

Sample Type

Urine 20mL ( early morning ) or 24 hour urine collection ( no preservative ).
Requests from outside Sheffield: transport at ambient temperature via Royal Mail or Courier.

---

Reference Range

Negative ( no free light chains detected )

---

Turnaround Time

Within 5 days

---

Testing Frequency

Twice weekly

---

External Notes

Do NOT use urine samples containing boric acid, identified by the red Universal top. Note the 24 hour urine volume on the request form and forward this together with a 20ml aliquot to Immunology NGH.

---

Patient Preparation

Patient requires one 24 hour urine bottle ( no preservative ) if obtaining a 24 hour urine sample.

---

References

PRU Handbook of Clinical Immunochemistry. 9th Edition. 2007. [Ref 1]
Smith A, et al. Guidelines on the diagnosis and management of multiple myeloma 2005. Br J Haem. 2006. 132:410-451. [Ref 2]
Siede WH and Regeniter A. Proteinuria - Diagnostics and interpretation with marker proteins. From the meeting; Proteins: from the laboratory to the Clinic. New Scientific Company. 2nd Edition. 2001. [Ref 3]
Graziani M, et al. Guidelines for the analysis of Bence Jones Protein. Clin Chem Lab Med. 2003. 41( 3 ):338-346. [Ref 3]
Rajkumar S, et al. International myeloma working group updated criteria for the diagnosis of multiple myeloma. 2014. Lancet Oncology, 15:e538-548.
Bird JM, et al. Guidelines for the diagnosis and management of multiple myeloma 2014. 2014. British Committee for Standards in Haematology ( BCSH ), UK myeloma Forum.NICE Guideline ( NG35 ) Myeloma: diagnosis and management. February 2016 ( updated October 2018 ).

---

See Also

Immunoglobulins
Free Light Chains

Please note: the above information is subject to change and we endeavour to keep this website up to date wherever necessary.