Test ID: EPU
Electrophoresis, Protein, Urine
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Monitoring patients with monoclonal gammopathies
Urine protein electrophoresis alone is not considered an adequate screening for monoclonal gammopathies
Profile Information A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| PTU | Protein, Total, U | Yes | Yes |
| PEU | Protein Electrophoresis, U | No | Yes |
Reflex Tests Lists test(s) that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial test(s)
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| IFXU | Immunofixation, U | No | No |
Testing Algorithm Delineates situation(s) when tests are added to the initial order. This includes reflex and additional tests.
If a discrete electrophoresis band is identified, the laboratory will evaluate the urine protein electrophoresis and, if necessary, perform immunofixation at an additional charge.
Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test
Method Name A short description of the method used to perform the test
PTU/8261: Dye Binding (Pyrogallol Red)
PEU/8244: Agarose Gel Electrophoresis
IFXU/82025: Immunofixation
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Immunology Profile (Pr Elect)
Macroglobulins
Protein Elect+Immunofixation (ALWAYS ORDER 82441)
Protein Electrophoresis+Total Protein
SPE (Serum Protein Electrophoresis)
SPEP (Serum Protein Electrophoresis)
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Collection Container/Tube: Clean, plastic urine collection container
Submission Container/Tube: Plastic, 60-mL urine bottle
Specimen Volume: 50 mL
Collection Instructions:
1. Collect a 24-hour urine specimen.
2. No preservative.
Additional Information:
1. 24-Hour volume is required.
2. If a serum specimen on the same patient will also be submitted, order PEL/80085 Electrophoresis, Protein, Serum under a separate order.
3. See Urine Preservatives in Special Instructions for multiple collections. NOTE: The addition of preservative or application of temperature controls must occur within 4 hours of the collection.
Urine Preservative Collection Options
| 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 |
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | NA |
| Lipemia | NA |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Urine | Refrigerated (preferred) | 14 days |
| Frozen | 5 days | |
| Ambient | 72 hours |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
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.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
PROTEIN, TOTAL
> or =18 years: <102 mg/24 hours
Reference values have not been established for patients that are <18 years of age.
ELECTROPHORESIS, PROTEIN
If protein concentration is abnormal, 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
Reference value applies to 24-hour collection. Specimens collected for periods other than 24 hours will be reported in concentration units.
Interpretation Provides information to assist in interpretation of the test results
A characteristic monoclonal band (M-spike) is often found in the urine of patients with multiple myeloma (MM). The initial identification of an M-spike or an area of restricted migration should be followed by MPSU/8823 Monoclonal Protein Study, Urine that includes 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 >1 g/24 hours is consistent with a diagnosis of MM or macroglobulinemia.
The presence of a small amount of monoclonal light chain and proteinuria (total protein >3 g/24 hours) which 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 the disorder. MPSU/8823 Monoclonal Protein Study, Urine that includes immunofixation should be performed if the clinical suspicion is high.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Patients suspected of having a monoclonal gammopathy may have a normal urine protein electrophoretic pattern, and these patients should have immunofixation (MPSU/8823 Monoclonal Protein Study, Urine) performed. Monoclonal gammopathies are rarely seen in patients <30 years of age.
Hemolysis may cause a discrete band on protein electrophoresis, which will be negative on immunofixation.
Penicillin may split the albumin band.
Radiographic agents may produce an uninterpretable pattern.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Kyle, RA, Katzmann, JA, Lust, JA, Dispenzieri A: Clinical indications and applications of electrophoresis and immunofixation. In Manual of Clinical Laboratory Immunology. 6th 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. 6th edition, Edited by NR Rose, RG Hamilton, B Detrick: 6th edition. Washington, DC. ASM Press, 2002, pp 71-91
Method Description Describes how the test is performed and provides a method-specific reference
Urine proteins are separated in an electric field according to their size, shape, and electric charge (Helena SPIFE 3000). The separation is performed on agarose gels (Helena SPIFE SPE Vis Gel). The proteins are visualized by staining with acid blue and the intensity of staining is quantitated by densitometry (Helena Quick Scan 2000). Multiplying by the urine protein concentration (Coomasie blue) converts the percentage of protein in each fraction into urine concentration. (Instruction manual: Helena SPIFE 3000; package insert: Helena SPIFE SPE Vis Gel, 2001; Kyle RA, Katzmann JA, Lust JA, Dispenzieri A: Clinical indications and applications of electrophoresis and immunofixation. In Manual of Clinical Laboratory Immunology. 6th edition. Edited by NR Rose, RG Hamilton, B Detrick: Washington, DC, ASM Press, 2002 pp 71-91)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Protein, total: Monday through Sunday; Continuous
Electrophoresis, protein: Monday through Saturday; 12:00 p.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
84156-Protein, total
84166-Electrophoresis, protein
86335-Immunofixation (if appropriate)
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 2776 | Albumin | 17819-4 |
| TP2 | Total Protein | 2889-4 |
| TM23 | Collection Duration | 13362-9 |
| 2777 | Alpha 1-Globulin | 17811-1 |
| 2779 | Alpha 2-Globulin | 17813-7 |
| VL21 | Urine Volume | 19153-6 |
| CONC1 | Concentration | 35663-4 |
| 2780 | Beta-Globulin | 17815-2 |
| 2781 | Gamma-Globulin | 17817-8 |
| 2833 | A/G Ratio | 44293-9 |
| 21446 | M spike | 42482-0 |
| 22307 | M spike | 42482-0 |
| 21447 | Impression | 32210-7 |
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