MGUS I need help understanding my lab report.

@nsnipes11 , I'm sorry you didn't get to discuss your MGUS concerns with your doctor. It can be hard to stay on track if they have a lot of things to go over.

I started to take a crack at comparing your immunoglobulin test values here with the Mayo (at least) standard ranges for those tests, and then realized that I don't know if the amounts are in mg/dL or mg/L. It makes a big difference! And different labs use different reference ranges for some lab tests.

Do you possibly have the reference ranges for those lab tests in your reports, and the units of measure (mg/dL vs. mg/L)? If so, maybe I or someone here can help put the results in perspective.

Even so, it can be tough to do without knowing your other physical conditions that can affect some of the measures, especially since most of us don't have the medical knowledge to figure out how one condition can affect another. I'm just empathetic because I'm trying to assess my own situation.

Best wishes, Nancy

Agree with above from pmm. One idea is use your patient portal if you think of follow up questions after your appointment.
Sometimes the doctor screens those and other times they respond, which is more informative.

Nancy,

It's mg/dL.
Other conditions:
peripheral neuropathy (neurologist said all sensory nerves in legs were "shot")'
cervical stenosis and severe degenerative disease (cervical and lumbar)
osteoporosis (before I was diagnosed with MGUS)
coronary artery disease (one stent), mitral valve regurgitation (moderate), PVCs.
asthma (mild to moderate)
GERD
Barrett's Esophagus (under control)
bladder and two other prolapses fixed with surgery
Beginning macular degeneration (under control)

I hope this helps, Nancy. I just need to know when to consider another doctor. I really don't have much time to rock the boat if I don't need to. If everything is stable, like she says it is then I won't do a thing. I have too much on my plate to worry about anything else unnecessarily. Thank you so much for attempting to help me understand my report.

@nsnipes11 , I'm going to take a crack at just listing the reference ranges with footnotes for the online sources for the immunoglobulin and kidney test results that you mentioned. I can't do much interpretation, not being qualified to do so. I hope it will help, though.

You wrote: "... immunofixation shows IgG monoclonal protein with lambda light chain." I'm listing the values you then reported with a reference (normal) range for each one.

The caveat is that different labs may use varying ranges for the same tests, depending on their processes. I think that the immunoglobulin values are probably (?) pretty standard, but I'm not sure about glucose, creatinine, and other blood values. I think that different labs might vary more on those. Anyway:

"< " means "less than".
">" means "greater than".

M-SPIKE
- M-spike = 1.5 mg/dL
--- Mayo Labs ref : IgG < 3 mg/dL may be consistent with MGUS or a number of other monoclonal gammopathies. *
--- IgG > 3 mg/dL is consistent with multiple myeloma. *

So your M-spike is square in the middle of the reference range for MGUS.

IMMUNOGLOBULIN G
- IgG = 1,819 mg/dL
--- Mayo Labs (normal) ref range: at age > or =18 years: 767-1,590 mg/dL *
--- --- So you have somewhat higher IGg than Mayo Labs' reference range. Other labs may state this range somewhat higher or lower. Problem is, I can't figure out what a "concerning" high level might be, as opposed to "slightly high". And the IgG level can go up for reasons other than MGUS, like a recent infection, autoimmune problems, and others.

KAPPA/LAMBDA RATIO
- K/L Ratio = 0.39
--- Mayo Labs ref range: 0.26-1.65 *

LAMBDA FLC
- Lambda FLC = 27.00 mg/dL
--- Mayo Labs ref range: 0.57-2.63 mg/dL *

KAPPA FLC
- Kappa FLC = 10.53 mg/dL, calculated below
--- --- kappa / .39 = 27.00
--- --- 10.53 / .39 = 27.00
--- --- kappa = 10.53
--- Mayo Labs ref range: 0.33-1.94 mg/dL *

The kappa/lambda RATIO is within the normal range, but the kappa and lambda measures are each above the normal range. It's my (limited) understanding that a variety of factors can cause both types of free light chains to increase at the same time, including the kidneys having trouble clearing them*, or your body making more in the first place, which can happen with infections, inflammation, or some autoimmune diseases*. Or both.

Since kidney health may impact free light chain values in blood, I'll include those values, too.

CREATININE
- Creatinine = 1.1 mg/dL
--- Normal, female (American Kidney Fund): 0.6 - 1.1 mg/dL

eGFR
- eGFR = 53
--- Average, age 70+: 75

According to the National Kidney Fund and a few other places I spotted, the creatinine result is within normal range for a female, though at the top, and the eGFR is kinda lower than normal. But eGFR scores decline over our lifetime, so at close to 80, this score may be low, but not extremely so. I don't know. That'll be a question for a doctor, maybe in relation to previous eGFR results.

Which leads to this: You, as an insured patient and heck! a human being! deserve professional answers to your health questions. All of them. I can understand the doctor getting sidetracked in an appointment, but I can't quite grant your healthcare team that tolerance for not answering your Portal questions. If it were me, I think I'd politely repeat the message every three days until someone answered. Or find a doctor who is responsive, maybe even someone in the same practice. My neuropathy problem alone is forcing me to pound some doors.

Best wishes! ❤️
Nancy

REFERENCES

* IgG reference range: https://www.mayocliniclabs.com/test-catalog/overview/8156#Clinical-and-Interpretive
* IgG ranges for MGUS/MM: https://www.mayocliniclabs.com/test-catalog/overview/609783#Clinical-and-Interpretive
* K/L ratio, lambda, kappa ranges: https://www.mayocliniclabs.com/api/sitecore/TestCatalog/DownloadTestCatalog?testId=609782
* Both lambda and kappa have raised levels: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10253807/
* Creatinine: https://www.kidneyfund.org/all-about-kidneys/tests/serum-creatinine-test
* eGFR: https://www.kidney.org/atoz/content/gfr

@nsnipes11 , I'm going to take a crack at just listing the reference ranges with footnotes for the online sources for the immunoglobulin and kidney test results that you mentioned. I can't do much interpretation, not being qualified to do so. I hope it will help, though.

You wrote: "... immunofixation shows IgG monoclonal protein with lambda light chain." I'm listing the values you then reported with a reference (normal) range for each one.

The caveat is that different labs may use varying ranges for the same tests, depending on their processes. I think that the immunoglobulin values are probably (?) pretty standard, but I'm not sure about glucose, creatinine, and other blood values. I think that different labs might vary more on those. Anyway:

"< " means "less than".
">" means "greater than".

M-SPIKE
- M-spike = 1.5 mg/dL
--- Mayo Labs ref : IgG < 3 mg/dL may be consistent with MGUS or a number of other monoclonal gammopathies. *
--- IgG > 3 mg/dL is consistent with multiple myeloma. *

So your M-spike is square in the middle of the reference range for MGUS.

IMMUNOGLOBULIN G
- IgG = 1,819 mg/dL
--- Mayo Labs (normal) ref range: at age > or =18 years: 767-1,590 mg/dL *
--- --- So you have somewhat higher IGg than Mayo Labs' reference range. Other labs may state this range somewhat higher or lower. Problem is, I can't figure out what a "concerning" high level might be, as opposed to "slightly high". And the IgG level can go up for reasons other than MGUS, like a recent infection, autoimmune problems, and others.

KAPPA/LAMBDA RATIO
- K/L Ratio = 0.39
--- Mayo Labs ref range: 0.26-1.65 *

LAMBDA FLC
- Lambda FLC = 27.00 mg/dL
--- Mayo Labs ref range: 0.57-2.63 mg/dL *

KAPPA FLC
- Kappa FLC = 10.53 mg/dL, calculated below
--- --- kappa / .39 = 27.00
--- --- 10.53 / .39 = 27.00
--- --- kappa = 10.53
--- Mayo Labs ref range: 0.33-1.94 mg/dL *

The kappa/lambda RATIO is within the normal range, but the kappa and lambda measures are each above the normal range. It's my (limited) understanding that a variety of factors can cause both types of free light chains to increase at the same time, including the kidneys having trouble clearing them*, or your body making more in the first place, which can happen with infections, inflammation, or some autoimmune diseases*. Or both.

Since kidney health may impact free light chain values in blood, I'll include those values, too.

CREATININE
- Creatinine = 1.1 mg/dL
--- Normal, female (American Kidney Fund): 0.6 - 1.1 mg/dL

eGFR
- eGFR = 53
--- Average, age 70+: 75

According to the National Kidney Fund and a few other places I spotted, the creatinine result is within normal range for a female, though at the top, and the eGFR is kinda lower than normal. But eGFR scores decline over our lifetime, so at close to 80, this score may be low, but not extremely so. I don't know. That'll be a question for a doctor, maybe in relation to previous eGFR results.

Which leads to this: You, as an insured patient and heck! a human being! deserve professional answers to your health questions. All of them. I can understand the doctor getting sidetracked in an appointment, but I can't quite grant your healthcare team that tolerance for not answering your Portal questions. If it were me, I think I'd politely repeat the message every three days until someone answered. Or find a doctor who is responsive, maybe even someone in the same practice. My neuropathy problem alone is forcing me to pound some doors.

Best wishes! ❤️
Nancy

REFERENCES

* IgG reference range: https://www.mayocliniclabs.com/test-catalog/overview/8156#Clinical-and-Interpretive
* IgG ranges for MGUS/MM: https://www.mayocliniclabs.com/test-catalog/overview/609783#Clinical-and-Interpretive
* K/L ratio, lambda, kappa ranges: https://www.mayocliniclabs.com/api/sitecore/TestCatalog/DownloadTestCatalog?testId=609782
* Both lambda and kappa have raised levels: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10253807/
* Creatinine: https://www.kidneyfund.org/all-about-kidneys/tests/serum-creatinine-test
* eGFR: https://www.kidney.org/atoz/content/gfr

Nancy,
I can't thank you enough! This helps me quite a bit. I, too, have had bone marrow biopsies. One at the very beginning, and one by accident (when my records were confused with someone else). The biopsies both showed about 5% plasma cells. The last one was done in 2019.

A bit of explanation about my current doc. I had a very good hemo/onc that left after a couple of years to practice at Emory in Atlanta. I just stayed with the incoming doctor. She, too, is a hemo/onc. I've had MGUS for 10 years, so I'm pleased that I'm still in the MGUS category. About her bedside manners: For me, they aren't good. When I asked about pain in my hips (which I understand comes with myeloma), she questioned me whether or not I thought it was due to Myeloma. I said "no" since I also have osteoporosis and lumbar and cervical disk disease. I asked about a urinary issue, and she came back with the same thing. I decided not to question further, but I am more and more disenchanted with her. I hate to pull up roots and move to another doctor as I'm seeing a number of docs now, with most issues remaining stable. But ... if my numbers go up, and there is any question that my diagnosis is changing, I will change doctors.

Thank you so much for all the work you've done on my behalf! I haven't sorted through the information under References, but I will. I am still working two weeks out of the month, proofreading for an electric company, so once I've completed my work, I'll get back to this.

Again, Nancy, thank you! You are a blessing!

Nan

Nan (@nsnipes11 ),

I'm so glad if any of that is helpful! It sounds like your MGUS is doing well. (I'd still double-check your kidney values with your doctor, if you haven't.)

Yeah, I also question why your doctor would bring your other questions back to MGUS. Sounds a little weird or presumptive. But it can be hard to find good ones that you really like, unfortunately. I'm going to see one today that has been a bit snippy with me about PN and MGUS labs - ick.

But onwards and upwards!

Nancy

I sure hope your doctor really listens to you and your concerns. It really does mean a lot, as you know.
Let me know how it goes.

Nan