What tests are done on a 24-hour urine sample? Why are they still necessary?

[Music] what tests are done on a 24-hour urine sample why are they still necessary another test that we use which is kind of difficult for patients is a 24-hour urine sample and what's measured usually in that 24-hour collection are two different things one is often the total amount of protein and i'm going to get back to that in a minute but then just like in the serum in the urine you can also run what's called a urine protein electrophoresis same principle you're taking protein out of the urine and concentrating it and then you're running it against an electric gradient now as opposed to serum people really have very small amounts of immunoglobulins in their urine so usually the normal value for that test in a in a person who does not have myeloma should be close to zero people who have myeloma a portion of them will have a large amount of monoclonal protein in the urine that can exactly mimic what's in the serum but sometimes it can be just that particular light chain now one of the other things that we use a 24-hour urine test though for is some patients have large amounts of a normal protein called albumin in that 24-hour urine collection and maybe only a very tiny amount of monoclonal protein that combination often signals to us to look for a disorder called amyloidosis that we won't speak about today but it is a related plasma cell disorder but but actually quite different than myeloma in the case of multiple myeloma what you might find is predominantly light light chains now those light chains when they come down in the urine historically have been called benz jones and benz jones is synonymous with lychee so it was called ben's jones proteinuria meaning a protein in the urine if you read their reports carefully more often they will say perhaps a small igg kappa and that's because a tiny amount of the large one can filter plus kappa and it's mostly the light chain that filters down into the urine so you want to do that for measuring before we had the free latching this would be a way in which someone could detect what was called back then the benz jones escape meaning if you had a patient that went from producing igg kappa to kappa only you might suddenly see that the igg was dropping in the blood but the patient appeared to be progressing with myeloma and if you were not to do the urine you wouldn't know that because they didn't have the free light gene because the protein was coming down into the urine so that's what was called the vance jones escape well nowadays most of that honestly can be detected through the through the blood so in my particular practice i only do collection of urine for difficult uh circumstances or at the beginning now there's there's another important point that one must look at when you first do the the urine collection and that is looking for an excessive amount of albumin in the urine and the reason for that is when when we doctors see a lot of albumin and if it reaches a certain level we call that nephrotic syndrome so it's a protein spilling disorder of the kidney and that would be a big red flag for someone to say maybe this patient has amino doses and this would have very profound implications on how we think about a person who has a newly found monoclonal protein if i have a patient who say has a small igg it has some free light chain abnormalities but they don't have anemia or the calcium is normal normally we would say we're going to observe that it could be an mgos but if that same person has a lot of amount of this protein in the urine i would investigate further for ammunitions and if amyloidosis were to be documented that person needs immediate treatment because you want to prevent the complications for amyloidosis so that's why it's so important to pay attention to that you know right at the beginning of an evaluation [Music]