Type of test Blood, urine, fluid analysis

Normal findings

 Beta₂-microglobulin:

 Blood: 0.7-1.8 mcg/mL Urine: ≤ 300 mcg/L

Cerebrospinal fluid (CSF):

 0-2.4 mg/L

Retinol binding protein:

 Urine: < 163 mcg/24 hours

Alpha-1-microglobulin:

 Urine: < 50 years: < 13 mg/g creatinine

≥ 50 years: < 20 mg/g creatinine

Test explanation and related physiology

 β₂m is increased in patients with malignancies (especially B-cell lymphoma, leukemia, or multiple myeloma), chronic infections, and chronic severe inflammatory diseases.

β2m, alpha-1-microglobulin, and retinol binding proteins pass freely through glomerular membranes and are almost completely reabsorbed by renal proximal tubule cells. Because of extensive tubular reabsorption, under normal conditions very little of these proteins appear in the final excreted urine. Therefore an increase in the urinary excretion of these proteins indicates proximal tubular disease or toxicity or impaired proximal tubular function. Therefore these proteins are helpful in differentiating among various types of renal disease. In patients with aminoglycoside toxicity, heavy metal nephrotoxicity, or tubular disease, protein urine levels are elevated. Excretion is increased 100 to 1000 times normal levels in cadmium-exposed workers. This test is used to monitor these workers.

β2 m is particularly helpful in the differential diagnosis of renal disease. If blood and urine levels are obtained simultaneously, one can differentiate glomerular from tubular disease. In glomerular disease, because of poor glomerular filtration, blood levels are high, and urine levels are low. In tubular disease, because of poor tubular reabsorption, the blood levels are low, and urine levels are high. Blood levels increase early in kidney transplant rejection.

Increased CSF levels of β₂m indicate central nervous system (CNS) involvement with leukemia, lymphoma, HIV, or multiple sclerosis.

Interfering factors

• β₂m is unstable in acid urine.

Procedure and patient care

 Before

* Explain the procedure to the patient to minimize anxiety.

 During

 Blood

 • Collect a venous blood sample in a red-top tube.

Urine

* Instruct the patient to begin the 24-hour collection after voiding. Follow guidelines on inside front cover.

 • A random urine level can also be used as a specimen when corrected for creatinine.

 After

• Apply pressure to the venipuncture site.

Abnormal findings

 Increased urine levels

- Renal tubule disease

- Drug-induced renal toxicity

- Heavy metal-induced renal disease

- Lymphomas, leukemia, myeloma

 Increased serum levels

- Lymphomas, leukemia, myeloma

- Glomerular renal disease

- Renal transplant rejection

- Viral infections, especially HIV and cytomegalovirus

- Chronic inflammatory processes

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