NOV 14, 2018 1:30 PM PST

Challenges of PTH Testing in Patients with CKD

C.E. Credits: P.A.C.E. CE Florida CE
Speaker
  • Director, Endocrine Laboratory, Mayo Clinic
    Biography
      Ravinder J. Singh, Ph.D., is the director of the Mayo Clinic Endocrine Laboratory. He has a focused area of investigation that has broad applicability to the field. Dr. Singh studies the application of liquid chromatography-tandem mass spectrometry (LC-MS/MS) to clinical laboratory analysis. Many of the methods that Dr. Singh developed are now considered reference methods. They have subsequently been utilized for method standardization efforts as well as to establish clinical disease correlates, which he has published with his collaborators.

      Dr. Singh's work has directly contributed to improving methods for the clinical diagnosis of Cushing's disease, pheochromocytoma and congenital adrenal hyperplasia. He continues to work to discover innovative ways to better understand the uses of LC-MS/MS in providing patients with faster and more accurate diagnoses.

    Abstract

    Second and third generations of PTH immunoassays currently available on the market demonstrate significant variability with up to 4.2 fold difference in measurements depending on the method used. Such significant variability is due to differences in antibodies specificity, lack of proper calibration or potential interferences. Pre-analytical conditions, such as sampling and storage, also play significant role in stability of PTH. The measurement inconsistencies between methods, as well as pre-analytical challanges complicate establishment of treatment and prevention cutoff values. The main effort of the PTH IFCC working group is to improve calibration of currently available assays using the available reference material.  

    The development of mass spectrometry-based reference measurement procedure is also underway. Ideally, the reference method should allow for differentiation of intact PTH (1-84) and its fragments. Standardization of PTH will provide an opportunity for accurate diagnostic and improved pathophysiologic insight into CKD-MBD, hypo- and hyperparathyrioidism.


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