Fig. 4.

Proposed screening pathway for myeloma in unexplained acute kidney injury (AKI) using Seralite® in patients at risk of myeloma. Screening of individual patients should be informed by risk factors such as age (> 60 years old) or other clinical features where myeloma could be suspected. The κ:λ ratio can be used to screen for myeloma and the FLC difference (dFLC – defined as the maximum FLC level minus the minimum FLC level) can be used to aid subsequent decisions for clinical management. If an abnormal κ:λ ratio is identified using the renal reference range of 0.14–2.02, a dFLC ≥400 mg/L can be used to indicate a high likelihood of cast neuropathy and stratify patients for consideration of immediate therapy to reduce serum FLC levels