{"id":10268,"date":"2020-04-23T04:01:26","date_gmt":"2020-04-23T01:01:26","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/lanturi-usoare-tip-kappa-in-urina\/"},"modified":"2025-01-31T14:22:42","modified_gmt":"2025-01-31T12:22:42","slug":"lanturi-usoare-tip-kappa-in-urina","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/lanturi-usoare-tip-kappa-in-urina\/","title":{"rendered":"\u0421\u0432\u043e\u0431\u043e\u0434\u043d\u044b\u0435 \u043b\u0435\u0433\u043a\u0438\u0435 \u0446\u0435\u043f\u0438 \u043a\u0430\u043f\u043f\u0430 \u0432 \u043c\u043e\u0447\u0435"},"content":{"rendered":"<p style=\"text-align: justify;\"><strong><em>Informa\u0163ii generale \u015fi recomand\u0103ri<\/em><\/strong><\/p>\n<p style=\"text-align: justify;\">Gamapatiile monoclonale, a c\u0103ror cauz\u0103 real\u0103 nu este cunoscut\u0103, includ mai multe afec\u0163iuni ce se caracterizeaz\u0103 prin proliferare aparent necontrolat\u0103 a celulelor implicate \u00een producerea de anticorpi asociat\u0103 cu sinteza \u015fi secre\u0163ia de c\u0103tre aceste celule a unei gamaglobuline omogene structural \u015fi\/sau a subunit\u0103\u0163ilor polipeptidice componente. Gamapatiile monoclonale cuprind: mielom multiplu (MM), mielom multiplu cu lan\u0163uri u\u015foare (LCMM), macroglobulinemia Waldenstrom (WM), mielom nonsecretant (NSMM), mielom multiplu cu evolu\u0163ie lent\u0103 (SMM), gamapatie monoclonal\u0103 cu semnifica\u0163ie nedeterminat\u0103 (MGUS), amiloidoza primar\u0103 sistemic\u0103 (AL) \u015fi boala depozitelor de lan\u0163uri u\u015foare (LCDD).<\/p>\n<p style=\"text-align: justify;\">Imunoglobulinele monoclonale secretate de aceste celule servesc ca marker de proliferare clonal\u0103, iar cuantificarea lor poate fi folosit\u0103 pentru\u00a0monitorizarea bolii<sup>2;3;5:6<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Moleculele de imunoglobuline sunt formate din dou\u0103 lan\u0163uri grele identice (\u03b1, \u03b4, \u03b5, \u03b3 sau \u03bc), care definesc clasa de anticorpi, \u015fi dou\u0103 lan\u0163uri u\u015foare identice (\u03ba sau \u03bb). Fiecare lan\u0163 u\u015for este legat covalent de un lan\u0163 greu, iar cele dou\u0103 lan\u0163uri grele sunt legate covalent \u00eentre ele la nivelul regiunii \u201ebalama\u201d.<\/p>\n<p style=\"text-align: justify;\">La persoanele s\u0103n\u0103toase, majoritatea lan\u0163urilor u\u015foare din ser exist\u0103 sub forma legat\u0103. Cu toate acestea, un nivel plasmatic sc\u0103zut de lan\u0163uri u\u015foare libere poate fi detectat \u00een serul persoanelor normale din cauza supraproduc\u0163iei \u015fi secre\u0163iei de lan\u0163uri u\u015foare de la nivelul plasmocitelor. \u00cen ser, lan\u0163ul u\u015for liber kappa exist\u0103\u00a0\u00een principal ca monomer (greutate molecular\u0103 de 22.5 kDa), iar lan\u0163ul u\u015for liber lambda, ca dimer legat covalent, cu o greutate molecular\u0103 de aproximativ 45 kDa. Acest lucru va conduce la o rat\u0103 de filtrare glomerular\u0103 diferen\u0163iat\u0103 pentru formele libere k \u015fi \u03bb \u015fi poate explica valoarea raportului \u03ba:\u03bb de 0.625\u00a0\u00een ser\u00a0\u00een compara\u0163ie cu raportul formelor legate care este de 2.0<sup>2;3;5:6<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Lan\u0163urile u\u015foare sunt, de obicei, filtrate la nivelul glomerulilor renali \u015fi apoi reabsorbite \u00een tubii proximali, astfel \u00eenc\u00e2t concentra\u0163ia urinar\u0103 este foarte mic\u0103 sau nedetectabil\u0103. Produc\u0163ia unor cantit\u0103\u0163i mari de lan\u0163uri u\u015foare monoclonale poate dep\u0103\u015fi \u00eens\u0103 capacitatea de reabsorb\u0163ie a rinichilor \u015fi acestea pot fi cuantificate cu u\u015furin\u0163\u0103\u00a0\u00een urin\u0103. Eviden\u0163ierea lan\u0163urilor u\u015foare monoclonale urinare (proteinurie Bence Jones) a fost folosit\u0103 ca marker de diagnostic pentru mielomul multiplu \u00eenc\u0103 din 1847, c\u00e2nd a fost descris de Dr. H. Bence Jones<sup>4;5<\/sup>.<\/p>\n<p style=\"text-align: justify;\">De\u015fi studiile efectuate au demonstrat superioritatea doz\u0103rii \u00een ser a lan\u0163urilor u\u015foare libere \u00een diagnosticul gamapatiilor monoclonale, exist\u0103 anumite situa\u0163ii \u00een care se indic\u0103 testarea simultan\u0103 a probelor de ser \u015fi urin\u0103:<\/p>\n<div style=\"text-align: justify; padding-left: 30px;\">\u2013 diferen\u0163ierea gamapatiilor monoclonale (MGUS de MM sau AL);<\/div>\n<div style=\"text-align: justify; padding-left: 30px;\">\u2013 cazuri neexplicate de insuficien\u0163\u0103 renal\u0103, insuficien\u0163\u0103 cardiac\u0103, fracturi, leziuni osteolitice, deficit imun<sup>3<\/sup>.<\/div>\n<p style=\"text-align: justify;\">De asemenea testul mai poate fi util \u015fi \u00een monitorizarea pacien\u0163ilor cu mielom multiplu cu lan\u0163uri u\u015foare la care componentul monoclonal seric este redus sau absent, iar componentul monoclonal urinar este mare<sup>5<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Specimen recoltat<\/em><\/strong>\u00a0 \u2013 urin\u0103 spontan\u0103<sup>1<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Recipient de recoltare<\/em><\/strong>\u00a0 \u2013 eprubeta pentru urin\u0103<sup>1<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Volum prob\u0103<\/em><\/strong> \u2013 un e\u015fantion de 10 mL<sup>1<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Stabilitatea probei<\/em><\/strong> \u2013 urina este stabil\u0103 <em>1 s\u0103pt\u0103m\u00e2n\u0103<\/em> la 2-8\u00b0C<sup>1<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Metoda<\/em><\/strong> - <span style=\"text-decoration: underline;\">nefelometric\u0103<\/span><sup>2<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Valori de referin\u0163\u0103:<\/em><\/strong><\/p>\n<div style=\"text-align: justify;\">Lan\u0163uri u\u015foare libere tip \u03ba: &lt;7.1 mg\/L<\/div>\n<div style=\"text-align: justify;\">Lan\u0163uri u\u015foare libere tip \u03bb: &lt;3.9 mg\/L<\/div>\n<div style=\"text-align: justify;\">Raport \u03ba:\u03bb \u2013 0.7 -6.2<sup>1<\/sup><\/div>\n<p style=\"text-align: justify;\"><strong><em>Interpretarea rezultatelor<\/em><\/strong><\/p>\n<p style=\"text-align: justify;\">\u00cen mod normal nivelurile de lan\u0163uri u\u015foare\u00a0\u00een urin\u0103 sunt reduse. Cre\u015fterea concentra\u0163iei urinare de lan\u0163uri u\u015foare kappa \u015fi\/sau lambda poate fi observat\u0103 at\u00e2t\u00a0\u00een tulbur\u0103ri benigne (policlonale) c\u00e2t \u015fi maligne (monoclonale).<strong><em>\u00a0<\/em><\/strong>Apari\u0163ia unor niveluri mai ridicate de lan\u0163uri u\u015foare policlonale \u00een urin\u0103 poate indica afec\u0163iuni renale sau boli autoimune.<\/p>\n<p style=\"text-align: justify;\">Un raport \u03ba:\u03bb anormal \u00een urin\u0103 se \u00eent\u00e2lne\u015fte \u00een bolile limfoproliferative maligne, cum ar fi mielomul multiplu. Astfel, un raport \u03ba:\u03bb &gt;6.2 sugereaz\u0103 prezen\u0163a lan\u0163urilor u\u015foare monoclonale de tip \u03ba; pe de alt\u0103 parte, un raport \u03ba:\u03bb &lt;0.7 sugereaz\u0103 prezen\u0163a lan\u0163urilor u\u015foare monoclonale de tip \u03bb.<\/p>\n<p style=\"text-align: justify;\">\u00cen specimenele de 24 ore, o cre\u015ftere de &gt; 25% \u00een concentra\u0163ie sugereaz\u0103 progresie sau recidiv\u0103; o sc\u0103dere cu mai mult de\u00a025% sugereaz\u0103 r\u0103spuns pozitiv la tratament<sup>3;5<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Limite \u015fi interferen\u0163e<\/em><\/strong><\/p>\n<p style=\"text-align: justify;\">Testul nu este suficient de sensibil pentru a detecta anomalii monoclonale mici, astfel c\u0103 un raport \u03ba:\u03bb normal nu exclude \u00eentotdeauna o protein\u0103 monoclonal\u0103. \u00cen aceste situa\u0163ii electroforeza proteinelor urinare cu imunofixare constituie o metod\u0103 mai sensibil\u0103<sup>5<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: small;\">\u00a0<\/span><\/p>\n<p style=\"text-align: justify;\"><strong><span style=\"font-size: small;\">\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/strong><\/p>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">1. Laborator Synevo. Referin\u0163ele specifice tehnologiei de lucru utilizate 2010. Ref Type: Catalog<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">2. Laboratory Corporation of America. Directory of Services and Interpretive Guide. Free \u03ba and \u03bb Light Chains Plus Ratio, Quantitative, Serum. www.labcorp.com 2010. Ref Type: Internet Communication<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">3. Laboratory Corporation of America. Directory of Services and Interpretive Guide. Free \u03ba and \u03bb Light Chains Plus Ratio, Quantitative, Urine. www.labcorp.com . 2010. Ref Type: Internet Communication<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">4. Katzmann JA, Kyle RA, Benson J, Larson DR, Snyder MR, et al. Screening Panels for Detection of Monoclonal Gammopathies In Clin Chem. June 2009;doi:10.1373\/clinchem.126664.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">5. Mayo Clinic. Mayo Medical Laboratories. Test Catalog. Immunoglobulin Total Light Chains, Urine. www.mayomedicallaboratories.com. Ref Type: Internet Communication.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">6. Mayo Clinic. Mayo Medical Laboratories. Test Catalog. Immunoglobulin Free Light Chains, Serum. www.mayomedicallaboratories.com. Ref Type: Internet Communication.<\/span><\/div>","protected":false},"excerpt":{"rendered":"<p><em><strong>\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/strong><\/em><\/p>\n<p>\u0418\u043c\u043c\u0443\u043d\u043e\u0433\u043b\u043e\u0431\u0443\u043b\u0438\u043d\u044b \u2014 \u044d\u0442\u043e \u0431\u0435\u043b\u043a\u043e\u0432\u044b\u0435 \u043c\u043e\u043b\u0435\u043a\u0443\u043b\u044b, \u043a\u043e\u0442\u043e\u0440\u044b\u0435 \u0432 \u043d\u043e\u0440\u043c\u0435 \u0441\u043b\u0443\u0436\u0430\u0442 \u0437\u0430\u0449\u0438\u0442\u043e\u0439 \u043e\u0442 \u043c\u0438\u043a\u0440\u043e\u043e\u0440\u0433\u0430\u043d\u0438\u0437\u043c\u043e\u0432 \u0438 \u0447\u0443\u0436\u0435\u0440\u043e\u0434\u043d\u044b\u0445 \u0432\u0435\u0449\u0435\u0441\u0442\u0432. \u0412 \u0441\u043e\u0441\u0442\u0430\u0432\u0435 \u0438\u043c\u043c\u0443\u043d\u043e\u0433\u043b\u043e\u0431\u0443\u043b\u0438\u043d\u043e\u0432 \u0435\u0441\u0442\u044c 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\u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f.<\/p>","protected":false},"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[1000,953],"product_tag":[],"class_list":{"0":"post-10268","1":"product","2":"type-product","3":"status-publish","5":"product_cat-biochimie-generala-sange-urina","6":"product_cat-teste-de-biochimie","8":"first","9":"instock","10":"sold-individually","11":"shipping-taxable","12":"purchasable","13":"product-type-simple"},"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product\/10268","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/comments?post=10268"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=10268"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_brand?post=10268"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_cat?post=10268"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_tag?post=10268"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}