Test Catalog

Test ID: HIGA    
Heavy-Light Chain IgA Kappa/IgA Lambda, Immunofluorescence

Useful For Suggests clinical disorders or settings where the test may be helpful

Immunofluorescent staining of IgA kappa and IgA lambda to aid in the diagnosis of monoclonal gammopathy-associated nephropathies

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

For the initial immunofluorescence (IF) stain performed, the appropriate bill-only test ID will be added and charged (IFPCI). For each additional IF stain performed, an additional bill-only test ID will be added and charged (IFPCA).

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Heavy chain/light chain (HLC) antibodies target conformational epitopes at the junctions of the heavy chain and light chain constant regions (CH1 and CL) of serum IgA kappa, IgA lambda, IgG kappa, IgG lambda, IgM kappa, and IgM lambda to provide quantitation of intact HLC pairs and aid in determining monoclonality. Direct HLC tissue immunofluorescence demonstrates that HLC antibodies complement conventional immunofluorescence in the pathologic diagnosis of monoclonal gammopathy-associated kidney lesions (such as heavy chain deposition disease and proliferative glomerulonephritis with monoclonal immunoglobulin deposits), can unmask polytypic IgA deposits, and assist in the pathologic distinction between type II and III cryoglobulinemic glomerulonephritis.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

An interpretive report will be provided.

Interpretation Provides information to assist in interpretation of the test results

Staining intensity is graded as negative (0), weak (trace, 1+), moderate (2+) and strong (3+).

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

No significant cautionary statements.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Leung N, Bridoux F, Batuman V, et al: The evaluation of monoclonal gammopathy of renal significance: a consensus report of the International Kidney and Monoclonal Gammopathy Research Group. Nat Rev Nephrol. 2019 Jan;15(1):45-59

2. Bridoux F, Leung N, Hutchison CA, et al: International Kidney and Monoclonal Gammopathy Research Group. Diagnosis of monoclonal gammopathy of renal significance. Kidney Int. 2015 ;87(4):698-711

3. Gagliardi A, Carbone C, Russo A, et al: Combined use of free light chain and heavy/light chain ratios allow diagnoses and monitoring of patients with monoclonal gammopathies: Experience of a single institute, with three exemplar case reports. Oncol Lett. 2016;12:2363-2370. doi: 10.3892/ol.2016.4965

4. Koulieris E, Panayiotidis P, Harding S, et al: Ratio of involved/uninvolved immunoglobulin quantification by Hevylite assay: Clinical and prognostic impact in multiple myeloma. Exper Hematol Oncol. 2012;1:9. doi: 10.1186/2162-3619-1-9

5. Joly F, Cohen C, Javaugue V, et al: Randall-type monoclonal immunoglobulin deposition disease: novel insights from a nationwide cohort study. Blood. 2019;133(6):576-587