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HelpTest ID: EPU Electrophoresis, Protein, 24 Hour, Urine
Reporting Name
Electrophoresis, Protein, 24 Hr, UUseful 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:
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:
Report Available
4 to 6 daysDay(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
UrineShipping Instructions
Refrigerate specimen during collection and send refrigerated.
Necessary Information
24-Hour volume is required.
Specimen Required
Supplies:
-Urine Container, 60 mL (T313)
-Sarstedt 5 mL Aliquot Tube (T914)
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 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 |
Special Instructions
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 |
Forms
If not ordering electronically, complete, print, and send a Renal Diagnostics Test Request (T830) with the specimen.
mml-Neuroimmunology, mml-Neuromuscular, mml-Autonomic, mml-Neuro-oncology, mml-Pediatric, mml-Pain, mml-Spinal-Cord