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Test Code EPU Electrophoresis, Protein, 24 Hour, Urine

Reporting Name

Electrophoresis, Protein, U

Useful For

Monitoring patients with monoclonal gammopathies

Profile Information

Test ID Reporting Name Available Separately Always Performed
PTU Protein, Total, U Yes Yes
PEU Protein Electrophoresis, U No Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
IFXU Immunofixation, U No No

Testing Algorithm

Urine protein electrophoresis alone is not considered an adequate screening for monoclonal gammopathies.

 

If a discrete electrophoresis band is identified, the laboratory will evaluate the urine protein electrophoresis and, if necessary, perform immunofixation at an additional charge.

 

The following algorithms are available in Special Instructions:

-Laboratory Approach to the Diagnosis of Amyloidosis

-Laboratory Screening Tests for Suspected Multiple Myeloma

Performing Laboratory

Mayo Medical Laboratories in Rochester

Specimen Type

Urine


Shipping Instructions


Refrigerate specimen during collection and send refrigerated.



Necessary Information


24-Hour volume is required.



Specimen Required


Supplies: Aliquot Tube, 5 mL (T465)

Submission Container/Tube: Plastic, 60-mL urine bottle and plastic, 5-mL tube (T465)

Specimen Volume: 50 mL

Collection Instructions:

1. Collect urine for 24 hours.

2. Aliquot specimen between containers.

3. Label specimens appropriately (60-mL bottle for protein electrophoresis and 5-mL tube for protein, total).

Additional Information: See Urine Preservatives in Special Instructions for multiple collections.


Specimen Minimum Volume

25 mL

Specimen Stability Information

Specimen Type Temperature Time
Urine Refrigerated (preferred) 14 days
  Frozen  5 days
  Ambient  72 hours

Reference Values

PROTEIN, TOTAL

<229 mg/24 hours

 

Reference values have not been established for patients <18 years of age.

 

Reference value applies to 24-hour collection. 

 

ELECTROPHORESIS, PROTEIN

The following fractions, if present, will be reported as a percent of the protein, total:

Albumin

Alpha-1-globulin

Alpha-2-globulin

Beta-globulin

Gamma-globulin

Day(s) and Time(s) Performed

Protein, total: Monday through Sunday; Continuously

Electrophoresis, protein: Monday through Saturday; 12 p.m.

Test Classification

This test has been cleared or approved by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

84156-Protein, total

84166-Electrophoresis, protein

86335-Immunofixation (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
EPU Electrophoresis, Protein, U In Process

 

Result ID Test Result Name Result LOINC Value
2776 Albumin 13986-5
TP2 Total Protein 2889-4
TM23 Collection Duration 13362-9
2777 Alpha 1-Globulin 13984-0
2779 Alpha 2-Globulin 13987-3
VL21 Urine Volume 19153-6
CONC1 Concentration 35663-4
2780 Beta-Globulin 13988-1
2781 Gamma-Globulin 13989-9
2833 A/G Ratio 44294-7
21446 M spike 42482-0
22307 M spike 42482-0
21447 Impression 32210-7

Clinical Information

Urine proteins can be grouped into 5 fractions by protein electrophoresis:

-Albumin

-Alpha-1

-Alpha-2

-Beta-globulin

-Gamma globulin 

 

The urine total protein concentration, the electrophoretic pattern, and the presence of a monoclonal immunoglobulin light chain may be characteristic of monoclonal gammopathies such as multiple myeloma, primary systemic amyloidosis, and light chain deposition disease.

 

The following algorithms are available in Special Instructions:

-Laboratory Approach to the Diagnosis of Amyloidosis

-Laboratory Screening Tests for Suspected Multiple Myeloma

Interpretation

A characteristic monoclonal band (M-spike) is often found in the urine of patients with monoclonal gammopathies. The initial identification of an M-spike or an area of restricted migration should be followed by immunofixation to identify the immunoglobulin heavy chain and/or light chain.

           

Immunoglobulin heavy chain fragments as well as free light chains may be seen in the urine of patients with monoclonal gammopathies. The presence of a monoclonal light chain M-spike of greater than 1 g/24 hours is consistent with a diagnosis of multiple myeloma or macroglobulinemia.

 

The presence of a small amount of monoclonal light chain and proteinuria (total protein >3 g/24 hours) that is predominantly albumin is consistent with amyloidosis (AL) or light chain deposition disease (LCDD).

 

Because patients with AL and LCDD may have elevated urinary protein without an identifiable M-spike, urine protein electrophoresis is not considered an adequate screen for these disorders and immunofixation is also recommended.

Clinical Reference

1. Kyle RA, Katzmann JA, Lust JA, Dispenzieri A: Clinical indications and applications of electrophoresis and immunofixation. In Manual of Clinical Laboratory Immunology. Sixth edition. Edited by NR Rose, RG Hamilton, B Detrick. Washington, DC, ASM Press, 2002, pp 66-67

2. Kyle RA, Katzmann JA, Lust JA, Dispernzieri, A: Immunochemical characterization of immunoglobulins. In Manual of Clinical Laboratory Immunology. Sixth edition, Edited by NR Rose, RG Hamilton, B Detrick. Washington, DC, ASM Press, 2002, pp 71-91

Analytic Time

2 days

Reject Due To

Hemolysis

NA

Lipemia

NA

Icterus

NA

Other

NA

 

Method Name

PTU: Turbidimetry

PEU: Agarose Gel Electrophoresis

IFXU: Immunofixation

Urine Preservative Collection Options

Note: The addition of preservative or application of temperature controls must occur within 4 hours of completion of the collection.

Ambient

Yes

Refrigerated

Preferred

Frozen

Yes

6N HCl

No

50% Acetic Acid

No

Na2CO3

No

Toluene

Yes

6N HNO3

No

Boric Acid

No

Thymol

Yes