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Test ID: EPU Electrophoresis, Protein, 24 Hour, Urine

Reporting Name

Electrophoresis, Protein, 24 Hr, U

Useful For

Monitoring patients with monoclonal gammopathies

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.

Profile Information

Test ID Reporting Name Available Separately Always Performed
PTU Protein, Total, 24 HR, U Yes Yes
PEU Protein Electrophoresis, 24 Hr, U No Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
IFXU Immunofixation, 24 Hr, 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

Report Available

3 to 5 days

Day(s) Performed

Protein, total: Monday through Sunday

Electrophoresis, protein: Monday through Friday

Clinical Reference

1. Abraham RS, Barnidge DR: Protein analysis in the clinical immunology laboratory. In: Detrick BD, Hamilton RG, Schmitz JL eds. Manual of Molecular and Clinical Laboratory Immunology. 8th ed. 2016:chap 4

2. Sykes E, Posey Y: Immunochemical characterization of immunoglobulins in serum, urine, and cerebrospinal fluid. In: Detrick B, Hamilton RG, Schmitz JL, eds. Molecular and Clinical Laboratory Immunology. 8th ed. Wiley; 2016:chap 9

Method Name

PTU: Turbidimetry

PEU: Agarose Gel Electrophoresis

IFXU: Immunofixation

Specimen Type

Urine


Shipping Instructions


Refrigerate specimen during collection and send refrigerated.



Necessary Information


24-Hour volume is required.



Specimen Required


Supplies:

-Urine Container, 60 mL (T313)

-Aliquot Tube, 5 mL (T465)

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

Specimen Volume: 50 mL

Collection Instructions:

1. Collect urine for 24 hours.

2. Aliquot at least 25-mL specimen in plastic, 60-mL urine bottle and at least 1-mL of specimen in plastic, 5-mL tube.

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

Additional Information: See Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens in Special Instructions for multiple collections.


Specimen Minimum Volume

25 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Urine Refrigerated (preferred) 14 days
  Frozen  5 days
  Ambient  24 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 mg/24 hours:

Albumin

Alpha-1-globulin

Alpha-2-globulin

Beta-globulin

Gamma-globulin

Test Classification

This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

84156

84166

86335-Immunofixation (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
EPU Electrophoresis, Protein, 24 Hr, U 81231-3

 

Result ID Test Result Name Result LOINC Value
607970 Albumin 6941-9
TP2 Total Protein, 24 HR, U 2889-4
TM23 Collection Duration 13362-9
607971 Alpha-1 globulin 6794-2
607972 Alpha-2 globulin 6795-9
VL21 Urine Volume 19153-6
607973 Beta globulin 94714-3
607974 Gamma globulin 94715-0
2833 A/G Ratio 44294-7
21446 M spike 42482-0
22307 M spike 42482-0
21447 Impression 32210-7

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

OK

Refrigerate

Preferred

Frozen

OK

50% Acetic Acid

No

Boric Acid

No

Diazolidinyl Urea

OK

6M Hydrochloric Acid

No

6M Nitric Acid

No

Sodium Carbonate

No

Thymol

OK

Toluene

No

Forms

If not ordering electronically, complete, print, and send a Renal Diagnostics Test Request (T830) with the specimen.

Mayo Clinic Laboratories | Neurology Catalog Additional Information:

mml-Neuroimmunology, mml-Neuromuscular, mml-Autonomic, mml-Neuro-oncology, mml-Pediatric, mml-Pain, mml-Spinal-Cord