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Bence Jones ProteinUrine

Definition
A quantitative Bence-Jones protein test
measures the specific level of abnormal
proteins (Bence-Jones proteins) in your
urine

Alternative Names
Immunoglobulin light chains - urine;
Urine Bence-Jones protein

How the Test is Performed


A clean-catch (midstream) urine sample is
needed.
Men or boys should first wipe clean the
head of the penis. Women or girls need to
wash the area between the lips of the
vagina with soapy water and rinse well.
As you start to urinate, allow a small
amount to fall into the toilet bowl (this
clears the urethra of contaminants). Then,
in a clean container, catch about 1 to 2
ounces of urine and remove the container
from the urine stream. Give the container
to the health care provider or assistant.

In infants, thoroughly wash the area


around the urethra. Open a urine collection
bag (a plastic bag with an adhesive paper
on one end), and place it on your infant.
For boys, the entire penis can be placed in
the bag and the adhesive attached to the
skin. For girls, the bag is placed over the
labia. Place a diaper over the infant (bag
and all).
Check your baby frequently and remove
the bag after the infant has urinated into it.
For active infants, this procedure may take
a couple of attempts -- lively infants can
displace the bag. The urine is drained into
a container for transport back to the health
care provider.

How the Test Will Feel


The test involves only normal urination,
and there is no discomfort.
Why the Test is Performed
Bence-Jones proteins are relatively small
and are filtered out by the kidneys. This
test is done to help diagnose medical
conditions that lead to protein in the urine
(proteinuria).
Your doctor may also order this test when
your urine protein level is high or if you
have other signs of multiple myeloma.
myeloma

Normal Results
A normal result means no Bence-Jones
proteins are found in your urine.
What Abnormal Results Mean
Bence-Jones proteins are rarely found in
urine. If they are, it is usually associated
with multiple myeloma.
An abnormal result may also be due to
Waldenstrom's macroglobulinemia, chronic
lymphocytic leukemia, or amyloidosis.
amyloidosis
Considerations
Urine immunofixation is the best test for
detecting Bence-Jones proteins

test

Normal
Negative
Positive
Amyloidosis (primary), benign monoclonal
gammopathy, cryoglobulinemia, Fanconi
syndrome (adult), hyperparathyroidism,
multiple myeloma (high levels indicate
poor prognosis), osteomalacia, and
Waldenstrm's macroglobulinemia.
macroglobulinemia

A low-molecular-weight, light-chain
immunoglobulin synthesized by malignant
plasma cells in the bone marrow and
initially broken down and reabsorbed by
the kidneys.

In multiple myeloma, such a large


amount of these proteins are produced
that they exceed the kidneys' capacity to
metabolize them.

This causes them to spill into the urine.


Prolonged production of Bence Jones
protein eventually causes degeneration of
the renal tubular cells, and the protein
accumulates in the tubules, causing
inclusions that may lead to renal failure.
Subsequently, increasing amounts of the
protein spill into the urine and can be
detected by thermal coagulation and acid
tests and confirmed by
immunoelectrophoresis

Preparation
Obtain a clean specimen container without
preservatives

Procedure
Obtain a 25-mL first morning-voided,
random urine specimen in a clean
container. A fresh specimen may be taken
from a urinary drainage bag.

Postprocedure Care
Send the specimen to the laboratory and
refrigerate.

Factors That Affect Results


1. Failure to refrigerate the specimen may
result in false-negative results.

2. False-positive results may be caused by


chronic renal insufficiency, connective
tissue diseases (such as rheumatoid
arthritis, systemic lupus erythematosus
[SLE], scleroderma, polymyositis, or
Wegener's granulomatosis), and other
malignancies (lymphoma, leukemia, and
metastatic cancer of the lung or of the
gastrointestinal or genitourinary tracts).

3. Drugs that may cause false-positive


results include aminosalicylic acid,
cephaloridine, chlorpromazine, penicillin
(high doses), promazine hydrochloride,
sulfisoxazole, and tolbutamide.
4. False-negative results may be caused by
very alkaline urine and severe urinary
tract infections in which urea splitting
occurs

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