Sometimes, with a targeted study of urine, the Bens Jones protein is determined, which is a marker of severe diseases.
To understand the importance of this substance, you need to have a general understanding of immunity. The immune system is represented by a group of cells that detect, capture and destroy pathological agents such as bacteria, viruses, and malignant neoplasm cells.
To ensure these functions, antibodies are synthesized – immunoglobulins. In bone marrow tumors, the production of immunoglobulins is impaired, an excess amount of their fragments enters the body with the blood flow. Bens Jones protein is a fragment of an immunoglobulin chain of amino acids.
Other names are paraprotein, light chains or L-chains. The light chains are excreted by the kidneys. As a pathological substance, paraprotein disrupts the function of the renal tubules and leads to the development of chronic renal failure.
Indications to appointment
Analysis is assigned to exclude:
- Multiple myeloma, solitary plasmacytoma.
- Hereditary primary systemic amyloidosis.
- Monoclonal gammopathy.
- Waldenstrom’s macroglobulinemia.
The suspicion of multiple myeloma is the most common and main indication for the study. The disease is manifested by pain in the spine, other bones, caused by the destruction of bone tissue and pathological fractures.
There are characteristic laboratory changes in blood tests. In approximately 20% of patients, light chains are detected on urinalysis.
Primary amyloidosis is often associated with multiple myeloma, but it can be an independent disease. Plasma cells produce a huge amount of protein – amyloid, which is deposited in organs and tissues, causing irreversible changes. Most often the kidneys are affected. Bens Jones protein is determined in urine.
Waldenstrom’s macroglobulinemia is a malignant lesion of the bone marrow, characterized by a syndrome of excessive blood viscosity. The presence of paraprotein has no great diagnostic value. However, a small amount is determined during research.
Monoclonal gammopathies are not in themselves malignant. Clinically, such states do not manifest themselves in any way.
With prolonged existence, they can transform into Waldenstrom’s myeloma or macroglobulinemia.
There is an opinion that such a transformation occurs necessarily after 10 to 40 years, but given the age of the patients (pathology is detected in persons over forty), it does not have time to develop.
Patients with monoclonal gammopathy should be monitored regularly, including urine testing for the presence of light chains.
The main syndromes for which the analysis is shown:
- Pain syndrome: intense pain in the bones, spine, not relieved by non-steroidal anti-inflammatory drugs, difficult to treat.
- Hemorrhagic syndrome: subcutaneous hemorrhages from a small-point petechial rash to large bruises, increased bleeding of the gums, nose and other bleeding.
- Hyperplastic syndrome: enlarged liver, spleen, lymph nodes.
- Amyloid lesions of organs and tissues.
- Intoxication symptoms: general malaise, weakness, sweating, increased body temperature from subfebrile to high.
- Laboratory changes: a persistent decrease in the level of erythrocytes, platelets, hemoglobin, acceleration of ESR in a general blood test, an increase in total protein in a biochemical blood test, the presence of M-protein.
Important: in addition to diagnosis and differential diagnosis, the study is carried out to assess the response to therapy and the prognosis of the course of the disease.
Preparation for examination and collection of urine
Preparation for the study:
- A confidential conversation between a doctor and a patient, explaining the purpose of the study, the need for preparation.
- Stopping alcohol and, if possible, diuretics 1-2 days before urine collection.
- For women, conduct research in the absence of menstruation.
Collection of urine:
The toilet of the external genitourinary organs is performed. The medium portion is collected in a special plastic container or clean glassware with a lid. Delivered to the laboratory within 2-3 hours.
To track the dynamics of the pathological process or differential diagnosis, a study of daily urine may be prescribed. Biomaterial is collected with each urination for 24 hours, starting with the first morning portion and ending in the morning of the next day. Stored in the refrigerator. At the end of the collection, it is immediately delivered to a medical facility.
Methods for determination of Bence Jones protein in urine and interpretation of the result
There are several ways to research. The qualitative method allows you to determine the presence or absence of protein. Quantification is used to establish the stage of the disease, assess the dynamics of the process and the presence of a response to therapy, and the prognosis for recovery.
The quality method is very simple. The urine filtrate heats up to 60 degrees, while a characteristic precipitate forms on the walls of the test tube, which dissolves with a further increase in temperature.
Quantitative methods for the determination of Bence Jones protein in urine:
- Electrophoresis with immunofixation. Sensitive. Accurate. The essence of the method: Proteins are divided into fractions by electrophoresis, paraprotein is fixed with immune serum, and is detected using special staining.
- Precipitation reaction with sulfonic acid: Urine filtrate is mixed with sulfosalicylic acid, heated to a certain temperature. The amount of paraprotein is determined in the precipitate.
In the analysis of a healthy person, paraprotein should not be present. The presence of the Bens Jones protein indicates the need to first rule out myeloma. The patient is assigned additional examination methods.
Remember: Systemic connective tissue diseases and some types of tumors can give a false positive reaction.
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