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  • Discrepant serum creatinine concentrations caused by paraprotein interference preceding diagnosis of monoclonal gammopathy of undetermined significance

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Case Reports: Reminder of important clinical lesson
Discrepant serum creatinine concentrations caused by paraprotein interference preceding diagnosis of monoclonal gammopathy of undetermined significance
  1. Miyuki Kobara1,2,
  2. Tohru Inaba3,
  3. Satoaki Matoba2 and
  4. Tetsuo Nakata1,2
  1. 1 Clinical Pharmacology, Kyoto Pharmaceutical University, Kyoto, Japan
  2. 2 Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
  3. 3 Department of Infection Control and Laboratory Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
  1. Correspondence to Dr Miyuki Kobara; kobara{at}mb.kyoto-phu.ac.jp

Abstract

We report a man in his 70s who presented with discrepant serum creatinine concentrations in different hospitals at the same time. Further examinations of these discrepancies revealed turbidity of the serum sample and, thus, a reagent reaction and false hypercreatinine caused by paraprotein interference were suspected. Serum protein electrophoresis revealed a small amount of monoclonal γ globulin (2.9 g/L), which may have been involved in paraprotein interference. Monoclonal λ-type IgG was detected in the serum, resulting in a diagnosis of monoclonal gammopathy of undetermined significance. Previous studies indicated paraprotein interference in serum containing monoclonal IgM or a large amount of IgG (> 25 g/L). Although this case of paraprotein interference induced by a small amount of IgG is rare, a discrepancy in creatinine results may be an indicator leading to the diagnosis of plasma cell proliferative diseases.

  • General practice / family medicine
  • Haematology (incl blood transfusion)
  • Medical management

https://doi.org/10.1136/bcr-2023-256242

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: MK and TI. The following authors gave final approval of the manuscript: MK, TI, SM and TN.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.