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BC: Articoli scritti da A. Terreni

Un caso di mieloma multiplo IgG kappa in cui la misura delle catene leggere libere ha evidenziato precocemente una ripresa di malattia di tipo “light chain escape”
A case of IgG kappa multiple myeloma where the measurement of the free light chains was an early marker of a “light chain escape” relapse
<p>Light chain escape (LCE) is a type of relapse where a serum free light chains (FLC) increase is observed, in the absence of a parallel increase of the original monoclonal component; this particular kind of relapse seems to be influenced by new therapeutic regimens. We present a case of a 55-years old man with a IgG kappa multiple myeloma (MM), who underwent double autologous bone marrow transplantation as first line therapy; after relapse, the patient was treated with lenalidomide/dexamethasone (LD). After more than three years of LD treatment, in September 2014, an increase of FLCs was observed, while serum and urine immunofixations remained negative until January and February 2015 respectively, when a LCE was diagnosed. Despite the new treatment, the patient died in June 2016. The FLCs measurement, although not reaching the IMWG criteria, detected relapse earlier than immunofixation. This case indicates that FLCs should be routinely performed during follow up of MM patients to ensure that LCE is not missed.</p>
Biochimica Clinica ; 41(3) e22-e24
Casi clinici - Case report
La diagnostica di laboratorio della malattia renale cronica in Italia: armonizzare è d’obbligo
The laboratory role in chronic kidney disease (CKD) in Italy: need of harmonization
<p>The diagnosis and&nbsp;classification of CKD are based on laboratory tests. Aim of this paper is to examine different aspects of the laboratory&nbsp;contribution to verify their harmonization at national level. We review relationships between laboratory and clinical&nbsp;organizations, the role of 2012 Kidney Disease Improving Global Outcomes (KDIGO) guidelines, the quality of&nbsp;creatinine and urine albumin measurements, the status of estimated glomerular filtration rate (eGFR) reporting, the use&nbsp;of cystatin C and testing plans. Questionnaires examining different aspects of the CKD diagnostics were sent out and&nbsp;EQAS for creatinine and urine albumin measurements were carried out. For creatinine measurement, enzymatic&nbsp;assays show the best performance, while for urine albumin a bias still exists between different methods. The eGFR is&nbsp;routinely reported by 75% of surveyed laboratories, but only 15% of them use the equation derived by the CKDEpidemiology&nbsp;Collaboration (CKD-EPI) study. For urine albumin, the recommended first morning void sample is used&nbsp;by ~60% of laboratories, but the wrong terminology of &ldquo;microalbuminuria&rdquo; is still used by &gt;40% of them. Cystatin C is&nbsp;offered by a minority of laboratories. In conclusion, even if an improvement can be observed during the recent years,&nbsp;efforts for a better alignment to international recommendations are needed. Often they just require cultural and&nbsp;organizational changes, without the availability of additional economic resources.</p>
Biochimica Clinica ; 39(6) 617-626
Opinioni - Opinions
Un caso di gammopatia monoclonale di significato renale in un paziente con glomerulopatia immunotattoide
A case of monoclonal gammopathy of renal significance in a patient affected by immunotactoid glomerulopathy
<p>Monoclonal gammopathy of renal significance is defined by the causal relationship between a small&nbsp;B-cell clone and the renal disease. Immunotactoid glomerulopathy is a rare glomerular disease characterized by<br />highly organized crystalline structure of Congo Red-negative immune deposits in the absence of systemic disease.&nbsp;We describe a 54 years-old man with non-nephrotic proteinuria and chronic renal failure. Laboratory findings revealed&nbsp;a serum monoclonal component. Renal histology showed a morphological pattern of membrano-proliferative&nbsp;glomerulonephritis; electron microscopy evidenced micro tubular structures within the mesangium measuring&nbsp;approximately 20 nm in thickness, similar to cryoglobulins. Renal immunofluorescence demonstrated in the deposits&nbsp;the same monoclonal component observed in serum, leading to a final diagnosis of immunotactoid glomerulopathy.</p>
Biochimica Clinica ; 39(6) e22-e24
Casi clinici - Case report
Valutazione dell’impatto delle raccomandazioni del Gruppo di Studio SIBioC Proteine sull’operatività dei laboratori italiani
Evaluation of the impact of recommendations by the SIBioC Proteins Study Group on Italian laboratory procedures
<p>Protein diagnostics is central in the management of subjects with monoclonal gammopathy. Laboratory&nbsp;should provide the most useful information to ensure the best patient outcome. To assess if recommendations issued&nbsp;after the 2007 survey have impacted on Italian laboratories contributing to a better harmonization of the post-analytical&nbsp;phase, the SIBioC Proteins Study Group has repeated a similar survey in February 2015. Twenty questions were&nbsp;electronically submitted to all SIBioC members using the software &quot;Survey monkey&quot;. 103 responses were collected,&nbsp;corresponding to ~6% of Italian laboratories. 47% of laboratories add an appropriate comment to the serum protein&nbsp;electrophoresis report when no monoclonal component (MC) is detected (36% in 2007). MC are correctly defined by&nbsp;63% of the laboratories; however, 11% reports MC as &ldquo;thickening&rdquo; or &ldquo;asymmetry&rdquo; or &ldquo;homogeneous peak&rdquo;. These&nbsp;ambiguous terms were used by roughly the same percentage (14%) in 2007. In 2015, the number of laboratories&nbsp;performing a MC typing only when requested by the clinician is reduced by 10% when compared to 2007. In both&nbsp;surveys, the percentage of laboratories performing and reporting the MC quantification is 77%. The worse results were&nbsp;obtained for Bence Jones protein (BJP) determination (not investigated in 2007): only 66% of laboratories utilize the&nbsp;immunofixation to detect the BJP and 57% do not quantify the protein. Although some progresses in harmonization of&nbsp;reporting are observed in CM testing over years, there is still room for significant improvement.</p>
Biochimica Clinica ; 39(6) 585-590
Contributi scientifici - Scientific Papers
Il fenomeno del “light chain escape”
Light chain escape phenomenon
A. Terreni  |  F. Balboni  | 
Biochimica Clinica ; 38(2) 156-157
Lettere all'Editore - Letters to the Editor
Il contributo della diagnostica proteica nella gestione delle gammopatie monoclonali
Protein diagnostics in the management of monoclonal gammopathies
<p>This document examines laboratory tests&nbsp;to be used for the management of monoclonal gammopathies in different clinical scenarios, from screening to&nbsp;monitoring and assessment of the response to therapy. The content is based on international recommendations and&nbsp;guidelines currently available. It includes sections on the analytical aspects of different tests&nbsp;(serum&nbsp;protein&nbsp;electrophoresis, typing and quantification of monoclonal components, Bence Jones protein determination and free&nbsp;light chain measurement) and on their clinical significance as well. Different clinical settings are examined: screening,&nbsp;diagnosis, risk stratification, monitoring and response assessment. For each of those, laboratory tests to be used are&nbsp;indicated. Aim of the document is to help clinical laboratories avoiding unnecessary tests, ensuring in the meantime&nbsp;that all the investigations required for a optimal patient management are carried out.</p>
Biochimica Clinica ; 38(1) 47-53
Documenti SIBioC - SIBioC Documents