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Test Code MSMN Membranous Nephropathy Target Antigen Identification, Mass Spectrometry, Tissue


Ordering Guidance


This test should be performed on cases with a confirmed diagnosis of membranous nephropathy. Ideally, these cases should already be confirmed as phospholipase A2 receptor (PLA2R) negative, based on PLA2R immunohistochemistry (IHC) or immunofluorescence (IF) testing, not PLA2R serology testing.

 

If PLA2R IHC or IF testing has not been performed, order test PLAIF / Phospholipase A2 Receptor (PLA2R), Renal Biopsy and submit the additional required specimen.



Additional Testing Requirements


If phospholipase A2 receptor testing using immunohistochemistry or immunofluorescence (IF) has not previously been performed, PLAIF / Phospholipase A2 Receptor (PLA2R), Renal Biopsy must also be ordered and will be charged separately. An additional frozen IF block or frozen unstained slides will be required.



Necessary Information


The following information is required. Testing will not proceed without this information.

1. Preliminary pathology report and clinical history

2. Immunofluorescence (IF) slides (or IF images via external storage device)

3. Electron microscopy (EM) images (via external storage device)

 



Specimen Required


Note: If the phospholipase A2 receptor (PLA2R) stain status has not yet been determined using immunohistochemistry or immunofluorescence (IF) testing, a frozen IF block or frozen unstained slides must also be submitted for the required PLA2R staining. For additional information, see PLAIF/ Phospholipase A2 Receptor (PLA2R), Renal Biopsy.

 

Specimen Type: Kidney tissue

Supplies: Pathology Packaging Kit (T554)

Container/Tube: Formalin-fixed, paraffin-embedded tissue block

Additional Information: Do not send fixed tissue slides. Testing can only be done on paraffin-embedded tissue blocks.


Secondary ID

620788

Useful For

Identification of antigen in membranous nephropathy

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
MSMNT Mass Spectrometry, MN TC No, (Bill Only) No
MNLCP Microdissection, Laser Capture, MN No, (Bill Only) No

Testing Algorithm

Requests for this test are reviewed by a Mayo Clinic renal pathologist prior to testing. After review of the submitted pathology report, electron microscopy images, phospholipase A2 receptor (PLA2R) staining results, and paraffin block, testing will proceed. If PLA2R results are not available, the pathologist may contact the ordering healthcare professional for the results or for additional specimen (frozen material/slides) to conduct the studies at Mayo Clinic Laboratories.

Method Name

Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)

Reporting Name

MN Target Antigen ID, LC MS, Ts

Specimen Type

Special

Specimen Minimum Volume

See Specimen Required

Specimen Stability Information

Specimen Type Temperature Time Special Container
Special Ambient (preferred)
  Refrigerated 

Reject Due To

Fixed tissue slides
Wet/frozen tissue
Cytological smears
Non-formalin fixed tissue
Nonparaffin embedded tissue		 Reject

Clinical Information

Membranous nephropathy (MN) is an autoimmune disease and a common cause of nephrotic syndrome in adults. MN results from glomerular accumulation of antigen-antibody complexes along the subepithelial region of the glomerular basement membranes. A series of novel antigens have recently been identified, and many of these antigen-associated MN have distinct clinical and pathologic findings as well as outcomes. This assay is intended to identify the antigens associated with MN using laser microdissection of MN glomeruli followed by mass spectrometry. The panel of MN antigens includes CNTN1, EXT1, EXT2, FAT1, HTRA1, NCAM1, NDNF, NELL1, PCDH7, PCSK6, PLA2R, SEMA3B, and THSD7A.

Reference Values

An interpretive report will be provided.

Interpretation

For results with a detected peptide profile, a description will be provided. The interpretation will include a diagnosis supported by the findings and a clinical reference. A simple description will be given for results that have no peptides detected or insufficient glomeruli.

CPT Code Information

82542

88380

LOINC Code Information

Test ID Test Order Name Order LOINC Value
MSMN MN Target Antigen ID, LC MS, Ts In Process

 

Result ID Test Result Name Result LOINC Value
620789 Interpretation 59465-5
620790 Participated in the Interpretation No LOINC Needed
620791 Report electronically signed by 19139-5
620792 Material Received 81178-6
620793 Disclaimer 62364-5
620794 Case Number 80398-1
620795 Gross Description 22634-0
620796 Addendum 35265-8