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HelpTest ID: MPSU Monoclonal Protein Study, 24 Hour, Urine
Reporting Name
Monoclonal Protein Study, 24 Hr, UUseful For
Monitoring patients with monoclonal gammopathies using 24-hour urine specimens
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 is followed by immunofixation to identify the immunoglobulin heavy chain and/or light chain.
Immunoglobulin free light chains as well as heavy chain fragments 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 primary systemic amyloidosis (AL) or light chain deposition disease (LCDD).
Because patients with AL or 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 |
| IFXU | Immunofixation, 24 Hr, U | No | Yes |
Testing Algorithm
The following algorithms are available:
Report Available
4 to 6 daysDay(s) Performed
Protein, total: Monday through Sunday
Electrophoresis, protein; Immunofixation: Monday through Friday
Clinical Reference
1. Kyle RA, Katzmann JA, Lust JA, Dispenzieri A: Clinical indications and applications of electrophoresis and immunofixation. In: Rose NR, Hamilton RG, Detrick B, eds. Manual of Clinical Laboratory Immunology. 6th ed. ASM Press; 2002:71-91
2. Keren DF, Humphrey RL: Clinical indications and applications of serum and urine protein electrophoresis. In: Detrick BD, Hamilton RG, Schmitz JL eds. Manual of Molecular and Clinical Laboratory Immunology. 8th ed. 2016:chap 8
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
-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
Betaglobulin
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
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| MPSU | Monoclonal Protein Study, 24 Hr, U | In Process |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 82025 | Immunofixation, 24 Hr, U | 33042-3 |
| 607970 | Albumin | 6941-9 |
| TP2 | Total Protein, 24 HR, U | 2889-4 |
| TM23 | Collection Duration | 13362-9 |
| 607971 | Alpha-1 globulin | 6794-2 |
| 606980 | Immunofixation Flag, 24 Hr, U | No LOINC Needed |
| 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-Movement-Disorders, mml-Demyelinating-Diseases, mml-Neuroimmunology, mml-Neuromuscular, mml-Autonomic, mml-Neuro-oncology, mml-Pediatric, mml-Pain, mml-Spinal-Cord