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HelpTest Code MCMRU Mast Cell Mediators, Random, Urine
Ordering Guidance
Patients with chronic mast cell activation often have chronically elevated N-methylhistamine (NMH) levels and will sometimes have intermittent NMH elevations. In these cases, a 24-hour urine collection is preferred. See MCM24 / Mast Cell Mediators, 24 Hour, Urine.
Specimen Required
Patient Preparation:
1. Patients taking monoamine oxidase inhibitors (MAOI) or aminoguanidine may have increased N-methylhistamine (NMH) levels. If medically feasible, patient must not take MAOI or aminoguanidine for 3 weeks before specimen collection. For more information see Cautions.
2. Patients taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) may have decreased concentrations of prostaglandin F2 alpha (23BP). If medically feasible, the patient should not take aspirin for 2 weeks or NSAIDs for 72 hours before specimen collection.
3. Patients taking 5-lipoxygenase inhibitor zileuton (Zyflo) may have decreased concentrations of leukotriene E4 (LTE4). If medically feasible, the patient should not take zileuton for 48 hours before specimen collection.
Supplies: Urine Container, 60 mL (T313)
Collection Container/Tube: Plastic urine container
Submission Container/Tube: Plastic, 60-mL urine bottle
Specimen Volume: 20 mL
Collection Instructions:
1. Collect a random urine specimen within a few hours of symptom onset.
2. No preservative.
Secondary ID
608379Useful For
Evaluating patients at risk for mast cell activation syndrome (eg, systemic mastocytosis) using random urine collections
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| CRTFR | Creatinine, Random, U | No | Yes |
| RLTE1 | Leukotriene E4, Random, U | Yes, (order RLTE4) | Yes |
| R23B1 | 2,3-dinor 11B-Prostaglandin F2a | Yes, (order 23BPR) | Yes |
| RNMH1 | N-Methylhistamine, Random | Yes, (order NMHR) | Yes |
Method Name
CRT2F: Enzymatic Colorimetric Assay
RLTE1, R23B1, RNMH1: Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Specimen Type
UrineSpecimen Minimum Volume
10 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Urine | Frozen | 28 days |
Reject Due To
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.Reference Values
LEUKOTRIENE E4:
≤104 pg/mg creatinine
2,3-DINOR 11B-PROSTAGLANDIN F2a:
<1802 pg/mg creatinine
N-METHYLHISTAMINE:
0-5 years: 120-510 mcg/g creatinine
6-16 years: 70-330 mcg/g creatinine
>16 years: 30-200 mcg/g creatinine
CREATININE:
<18 years: Not established
≥18 years: 16-326 mg/dL
Interpretation
Analytical reports within the scope of the individual assays will be provided when testing is complete.
Method Description
N-methylhistamine:
N-methylhistamine is extracted from urine using solid-phase extraction. The elute is analyzed using liquid chromatography tandem mass spectrometry (LC-MS/MS) and quantified using a stable isotope labeled internal standard.(Martens-Lobenhoffer J, Neumann HJ. Determination of 1-methylhistamine and 1-methylimidazoleacetic acid in human urine as a tool for the diagnosis of mastocytosis. J Chromatogr B Biomed Sci Appl. 1999;721[1]:135-140; Lueke AJ, Meeusen JW, Donato LJ, Gray AV, Butterfield JH, Saenger AK. Analytical and clinical validation of an LC-MS/MS method for urine leukotriene E4: A marker of systemic mastocytosis. Clin Biochem. 2016;49[13-14]:979-982. doi:10.1016/j.clinbiochem.2016.02.007)
2,3-Dinor-11beta-prostaglandin F2alpha:
2,3-Dinor-11beta-prostaglandin F2alpha (23BPG) is quantified in urine by LC-MS/MS. Deuterium-labeled 23BPG internal standard (d4-11BPGF2a) is added to all controls and specimens, which are then liquid/liquid extracted. The eluent is evaporated, and samples/QC are then reconstituted prior to LC-MS/MS analysis.(Unpublished Mayo method)
Leukotriene E4:
Leukotriene E4 (LTE4) is quantified in urine via multiplexed LC-MS/MS. Deuterium-labeled LTE4 internal standard is added to all standards/controls/samples, which are then filtered. After additional sample clean-up, this eluent is analyzed by LC-MS/MS.(Unpublished Mayo method)
Creatinine:
The enzymatic method is based on the determination of sarcosine from creatinine with the aid of creatininase, creatinase, and sarcosine oxidase. The liberated hydrogen peroxide is measured via a modified Trinder reaction using a colorimetric indicator. Optimization of the buffer system and the colorimetric indicator enables the creatinine concentration to be quantified both precisely and specifically.(Package insert: Creatinine plus Ver 2. Roche Diagnostics; V15.0, 03/2019)
Day(s) Performed
Monday, Tuesday, Thursday
Report Available
2 to 9 daysSpecimen Retention Time
14 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
CPT Code Information
82570
84150
82542
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| MCMRU | Mast Cell Mediators, Random, U | In Process |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| CRTFR | Creatinine, Random, U | 2161-8 |
| 620245 | N-Methylhistamine, Random, U | 13781-0 |
| 620241 | Leukotriene E4, Random, U | 33343-5 |
| 620243 | 2,3-dinor 11B-Prostaglandin F2a | 97658-9 |