My Lab Report

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To me at least, the lovely Blue Door watercolor by Andrew Wyeth is simplicity created by studied art.

Take a look at your lab report(s) and answer these questions. If you have two 24 hour urine collections this time answer from the more abnormal in every case. Here is help for reading these if you are confused. Here is more help.

But keep this in mind. I assume here you have personal physicians; that you have been screened properly to rule our systemic diseases as a cause of your stones; and that your other health issues are being looked after by your physicians. This kind of simplified approach is nice for otherwise healthy idiopathic calcium or uric acid stone formers. Others may need much more.

Section One: Initial Evaluation

Answer the questions.

The blue responses are actions you should take

  1. Is my urine volume less than 2.5 liters?
    1. No – It is high enough
      1. Was my collection representative of my usual life or was I showing off
        1. Representative
        2. Showing off – I should check another urine collected during my usual life
    2. Yes – Raise my fluid intake to 2.5 liters: 2.5 – my volume = my increase in fluids
  2. Is my urine calcium above 200 mg?
    1. No – It is not high enough to increase risk of stones
    2. Yes – It is high enough to increase risk of stones
      1. Is my urine sodium above 100 mEq (1500 mg)
        1. Yes – Lower my sodium intake to below 100 mEq (2300 mg); 1500 mg is ideal
        2. No – My sodium intake is not high
      2. Do I eat a lot of sweets – sugared foods?
        1. Yes – Reduce my sugar intake as it increases urine calcium
        2. No – My sugar intake is not high
      3. Do I eat at least 1000 mg of food calcium daily?
        1. Yes – People with hypercalciuria need diet calcium for their bones – continue this diet
        2. No – I need to eat at least 1000 mg of diet calcium daily
  3. Is my urine oxalate above 35 mg?
    1. No – My urine oxalate is not very high
    2. Yes – My urine oxalate is high enough to increase risk of stones
      1. Reduce high oxalate foods using the lists on this site
      2. I need to eat at least 1000 mg of diet calcium daily
      3. Is my urine oxalate above 80 mg?
        1. No – I can try diet to lower my urine oxalate
        2. Yes – My urine oxalate is so high my physician needs to review the matter and decide what to do
  4. Is my urine citrate below 400 mg?
    1. Yes – It is low enough to raise risk of stones
      1. Is my blood potassium low or do I take diuretics?
        1. Yes – My physician needs to provide potassium supplements
        2. No – Use beverages that provides supplemental alkali to raise my citrate
    2. No – It is not low enough to raise risk of stones
  5. Is my urine pH below 5.5
    1. Yes – My urine pH is low enough to pose a risk for uric acid stones
      1. Is my uric acid supersaturation above 1?
        1. No – Is my urine volume high?
          1. Yes – High volume is protecting me against uric acid stones
          2. No – Uric acid may be crystallizing; Raise my fluid intake to 2.5 liters: 2.5 – my volume = my increase in fluids
        2. Yes – Use beverages that provides supplemental alkali to raise my urine pH
    2. No – My urine pH does not pose a risk of uric acid stones

Select and print this list

Circle the actions you need to do and pin the list up where you will see it

  1. I should check another urine collected during my usual life
  2. Raise my fluid intake to 2.5 liters: 2.5 – my volume = my increase in fluids
  3. Lower my sodium intake to below 100 mEq (2300 mg); 1500 mg is ideal
  4. Reduce my sugar intake as it increases urine calcium
  5. I need to eat at least 1000 mg of diet calcium daily
  6. Reduce high oxalate foods using the lists on this site
  7. My urine oxalate is so high my physician needs to review the matter and decide what to do
  8. My physician needs to provide potassium supplements
  9. Use beverages that provides supplemental alkali to raise my citrate
  10. Use beverages that provides supplemental alkali to raise my urine pH

Get a follow up 24 hour urine test when all of the actions are in play

Section Two: Follow up Evaluations

Here is what to do when you have a follow up test

First answer the questions in Section One.

Then answer the questions here in Section Two

The blue responses are actions you should take

  1. Do I know what my stones have been made of?
    1. Yes – Look at the supersaturation(s) related to your stone(s); call these your relevant supersaturations
    2. No – All three supersaturations may be relevant
  2. Have all of my relevant supersaturations fallen by half?
    1. Yes –
      1. Am I still forming new stones
        1. No – Stay on my treatment and get another follow up in one year; if new stones form get it sooner
        2. Yes – Am I sure this 24 hour urine reflects my usual life?
          1. Yes – I may need medications; see my physician
          2. No – Get another 24 hour urine within the next 6 – 12 weeks
    2. No – Go back over the blue actions in section one
      1. Is my uric acid supersaturation one that has not fallen by half?
        1. Yes
          1. Is either blue action 2 or 10 in section one above suggested?
            1. Yes – Do the blue actions suggested in section one and obtain a new 24 hour urine
            2. No – Raise my fluid intake to 3 liters a day and obtain a new 24 hour urine
        2. No – Either my calcium oxalate or calcium phosphate supersaturation has not fallen
          1. Are any of blue actions 2 – 9 in section one suggested?
            1. Yes – Do the blue actions suggested in section one and obtain a new 24 hour urine
            2. No – Raise my fluid intake to 3 liters a day and obtain a new 24 hour urine

Select and print this list

Circle the actions you need to do and pin the list up where you will see it

  1. Stay on my treatment and get another follow up in one year; if new stones form get it sooner
  2. I may need medications; see my physician
  3. Get another 24 hour urine within the next 6 – 12 weeks
  4. Go back over the blue actions in section one
  5. Do the blue actions suggested in section one and obtain a new 24 hour urine
  6. Raise my fluid intake to 3 liters a day and obtain a new 24 hour urine

48 Responses to “My Lab Report”

  1. Stephanie

    Will adding in the recommended beverages to increase citrate affect urine pH? My urine citrate hovers Just below 400 so I would like to raise it some but my urine pH has been at or just above 6.2 on my last few Litholink reports.

    Reply
    • Fredric Coe, MD

      Hi Stephanie, When citrate is low be sure and think about all causes: Low potassium inadequate servings of fruits and veggies- 5 or more a day, and GI disorders. If you need more citrate, be sure you know why. Ask your physician or look at your labs. Is your supersaturation now half or less of what it was before you began treating yourself; I mean supersaturation with respect to the crystals in the stones you form. If it is, 400 mg/day of citrate is just at the point where stone risk begins. Regards, Fred Coe

      Reply
    • jharris

      Hi Stephanie,

      It might increase your urine pH a bit, but it is important to get your citrate levels up. If you have high pH levels, but your urine calcium level is within normal limits and you are drinking enough fluids to produce 2.5 liters of urine you will be in good shape. Hope this helps-

      Jill

      Reply
  2. Patti

    I got my results back from Litholink on my 24 hour urine. I am confused as to whether or not I should be taking Calcium. My urine volume was very low at 0.69, SS CaOx is 14.70, not a typo. Urine calcium is 127. Urine oxalate is 38. Urine citrate is 958. SS CaP is 3.95. Urine ph is 6.752. SS uric acid is 0.28. Sodium is 120. The Nurse Practitioner called today and said to just drink more fluids. I am thinking based on these results that I should be on a low oxalate diet and increase fluids. I am not sure if I should add OTC calcium or not. What do you think based on these results. I might add that I am an RN and have been a nurse for 23 years. I am 50 years old and have had 8 kidney stones over the last several years, approximately every other year. Thanks for the reply and your website is great.

    Reply
    • Fredric Coe, MD

      Hi Patti, Your urine volume is surely a serious liability. Calcium and citrate are not risk factors in you – you discovered that from the article. Urine oxalate is a bit high. You do not mention the type of stone you form, but your CaP SS is actually as bad as your CaOx SS: It takes about a SS of 4 – 5 to produce CaOx stones but for CaP anything above 1 will do. Like everyone who has a skeleton you should have 1,000 to 1,200 mg of diet calcium daily preferably from food. I would do that before worrying about an oxalate list. Here is my best on that. Get another 24 hour urine on fluids – lets do 2.5 liter urine or 3 liters fluid intake – and high diet calcium. Be sure and have the high calcium with the meals that will have substantial oxalate – the larger meals. Supplements are alright but food calcium is better. IF calcium and fluids are not enough to bring the SS down, then lower diet sodium – below 100 mEq preferably 65 mEq – the present US ideal intake. Regards, Fred Coe

      Reply
  3. James

    Hi Dr. Coe, someone else asked pretty much the same exact question I had, but I didn’t see an answer. I’ll just say it like they did and hope you can please clarify it. Thanks much
    I am trying to “understand my “LithoLink” 24-hour urine report, which has my pH of 6.491 indicating “increased risk for stone formation”, with a reference range of 5.8-6.2. I thought that the higher the number, the more alkaline, the less stone formation risk, with 7 the point of neutrality–so I thought I might need to become more alkaline. Thanks again for all your work and your help. “

    Reply
    • Fredric Coe, MD

      Hi James, There are two main calcium stone types – calcium oxalate and calcium phosphate. The former are indifferent to pH; the latter arise when pH is increased because the phosphate component takes on 2 negative charges with higher pH and they are required for binding with calcium. I do not know where you were told a higher urine pH prevents stones, it does not. The reason potassium citrate is used is to increase urine citrate, and an unfortunate byproduct is a rise of pH. I hope this is helpful. Regards, Fred Coe

      Reply
      • James

        Thanks Dr. Coe. My 24 hr. urine test was done by the company “Litholink” and ordered by my urologist. Urine pH was one of the many things tested, and on their scale of ‘decreased/increased risk for stone formation’ their reference range for pH is 5.8-6.2. My particular pH was 5.0, and according to their graph, that increases the risk of stone formation. Their written recommendation for my ‘very low urine pH’ is to treat with potassium citrate, to raise it. So doesn’t that mean, according to them anyway, that a higher pH will lower the risk? (My stone was 90% calcium oxalate and 10% uric acid.)

        Reply
        • Fredric Coe, MD

          Hi James, I wrote that Litholink report algorithm with John Asplin. The low pH can cause the uric acid component in your stone and treatment with potassium citrate is indeed a good idea. The increase of urine citrate – if any – will possibly reduce for calcium oxalate as well, but there may be other factors for that part such as urine calcium, oxalate, or volume. If so they all need treatment. Regards, Fred Coe

          Reply
  4. google

    My coder is trying to convince me to move to
    .net from PHP. I have always disliked the idea because of the
    costs. But he’s tryiong none the less. I’ve been using Movable-type on various
    websites for about a year and am nervous about switching to another platform.
    I have heard very good things about blogengine.net.
    Is there a way I can transfer all my wordpress posts into it?
    Any help would be really appreciated!

    Reply
    • Fredric Coe, MD

      Hi Bernard, I have no experience with this. I did a small site on Google and like it, but it is personal and does not have the utilities this one needs. Regards, Fred Coe

      Reply
  5. Wayne Lee

    I have experienced over 10 CaOx renal stones since 1970. Two would not pass and were treated surgically. Had left ESWL last week for 2 stones (5.4 & 7.2 mm) that were about 3 & 5 mm size 4 years ago. I have been on a low salt, low oxalate and increased calcium diet for years. I have the results from my 24 hr urine collected before the ESWL and the lab report on the stone that passed in August. My urologist has reviewed the urine results and does not recommend any change to my treatment plan. How can I arrange a personal consultation for Dr. Coe the review and comment on the results? I would prefer a reply to my email address. Thanks.

    Reply
  6. Kelly Stanley

    Hi Dr. Coe,
    I just got my 24 hr urine test back. My Doc prescribed hydroclorothiazide 12.5 mg once a day. I am apprehensive to take medicine. He also said reduce sodium and increase fluid. I enclosed some of the results. Is there anything else I should be doing to reduce my stone risk ? Thanks,Kelly
    Ph 6.372
    24 Hr Citrate 963
    24 Hr Oxalate 36
    24 Hr Uric Acid 0.691
    24 Hr Calcium 284
    Urine Volume 1.78
    Supersaturation Caox 7.77
    Supersaturation Cap 2.58
    Supersaturation Uric Acid 0.37

    Reply
    • Fredric Coe, MD

      Hi Kelly. Your doctor seems quite reasonable – what was the urine sodium?? You are hypercalciuric, and it would be good to raise your diet calcium intake to 1,200 mg and drop the sodium intake below 2000 mg, and see what your SS and urine calcium do. The drug would work even better if you lower your sodium and refined sugar intakes and perhaps might not even be needed. The urine oxalate may fall a lot with the high calcium intake. The drug is a reasonable choice, and if diet calcium sugar and sodium changes and lots of water are not enough you may well want to use it. The goal is for those supersaturations to fall at least by half, and your urine calcium to go below 200 mg/d and oxalate below 25 mg/d so you have a clear goal. Regards, Fred Coe

      Reply
  7. Brooke Weaver

    Dr Coe,
    Thank you for all of this information. How do I get an appointment with you? I stumbled upon your page after my urologist here in AR said I probably need to be referred to a specialist. I am currently 33 years old (female) and had my first kidney stone removal as a child at the age of 16. Since then, I have produced a mass amount of kidney stones (60+). I have had over 10 lithrotripsies and several other kidney stone related surgeries. I am averaging at least one surgery per year, for the last 7 years. My stones are calcium oxalate and I am taking potassium citrate and have for the past 6 or 7 years. Please help. Thanks so much!
    Brooke

    Reply
    • Fredric Coe, MD

      Hi Brooke, I practice at University of Chicago and you can just ask my secretary Kathleen Dineen – 773 702 1475. I will email you as well, so she gets a copy. Regards, Fred Coe

      Reply
  8. Cindy Wells

    Dr. Coe,

    Thank you for your amazing website! It is simply a mine of information. My husband has been struggling with kidney stones for the past year (he just had his 1st lithotripsy last week), and recently got back his 24 hr lab results: Urine 2.6 L, pH 6.1, Calcium 41.6mg, Sodium 98.3mEq, Citrate 317mg, Oxalate 173.9mg, Uric Acid 608.4mg, phosphorous 1170mg, potassium 86.6. His urologist simply told him “your citarates are mildly elevated, so cut high oxalate foods out of your diet, and come back in a year!” But based on my readings here, that doesn’t seem like enough. We were thinking 800mg calcium and 20mEq citrates in addition to lowering food oxalates. I should mention that due to excessive migraines (3-4) a week, my husband has had to cut dairy completely out of his diet, which I am sure is contributing. He also eats a relatively low carb diet. I am wondering if it is more appropriate to transition back to a more traditional diet (minus the diary, of course), or stick with his current diet and add all the citrate supplements and low oxalate foods…. We just didn’t get a lot of good guidance from the urologist! Thoughts? And thank you!

    Reply
    • Fredric Coe, MD

      Hi Cindy, I agree that his urine oxalate is in a very abnormal range. If you have copied correctly 174 mg/day of urine oxalate poses a danger of kidney damage. I am sure his personal physicians are also quite concerned. I would indeed reduce oxalate foods to very low levels and also add some calcium containing foods to each large meal – no supplements – and repeat this very promptly – in a week or two. If his urine oxalate level does not fall immediately below 80 or less I am sure his physicians will want to arrange for specialized consultation concerning this oxalate level. I cannot overly emphasize that this high a urine oxalate is potentially worrisome and needs attention and remedy. Regards, Fred Coe

      Reply
      • Cindy Wells

        Thank you so much for your response! I checked his report and his oxalate readings are truly that high. And his urologist is truly unconcerned. We are increasing his calcium and lowering his oxalate foods, and are trying to get in with a nephrologist. Hopefully we can get this taken care of soon! Thank you again!

        Reply
        • Fredric Coe, MD

          Hi Cindy, I cannot enough emphasize the need to recheck another urine and if it is the same have someone expert in this problem take the proper steps. In the meantime, have him eat a reasonably high sodium intake – I know that sounds odd but it is accurate – and avoid NSAID type drugs and any kind of dehydration; no diuretics of any kind. High oxalate conditions are dangerous and need resolution. Regards, Fred Coe

          Reply
  9. Peter C Raner

    Hi Dr. Coe, I wanted to make sure I understand this correctly–an over the counter potassium citrate in bulk is a reasonable price–it says “275 mg serving = Potassium Citrate 99 mg.” I read elsewhere that 99 mg = about 2.53 mEq. Is that correct? Also, I had/have CaOx stones, my urine oxalate with a diet change is now 21 (down from 80 a year ago) and my other values are all normal. However, my urine pH came back as 6.491, and I would like to nudge that up a bit. How much of this bulk supplement should I take? Thank you for your help.

    Reply
    • Fredric Coe, MD

      Hi Peter, The usual potassium citrate pill is 10 mEq so this is a very small dose size. But why would you want a higher urine pH? This one is plenty high! I would add nothing. Regards, Fred Coe

      Reply
      • Peter C Raner

        Thank you so much Dr. Coe for your fast reply, and for all the very helpful information you and your colleagues have taken the time to make available. I’m glad my pH is OK, and I’m happy not to have to worry about it, and just stick with the diet guidelines you suggest, which I have followed carefully–especially getting plenty of calcium–which reduced my urine oxalate from 80 to 21–something my urologist said he’s never seen just through a change in diet. (As I learned, my previous diet was primarily the highest oxalate foods!) My question reflected my confusion trying to understand my “LithoLink” 24-hour urine report, which has my pH of 6.491 indicating “increased risk for stone formation”, with a reference range of 5.8-6.2. I thought that the higher the number, the more alkaline, the less stone formation risk, with 7 the point of neutrality–so I thought I might need to become more alkaline. Thanks again for all your work and your help. Take care.

        Reply
  10. Hulda Smith

    Hi Dr. Coe,

    I experienced my first kidney stone in March of this year. The CT showed an additional 8 stones, 4 in each kidney. The largest approximately 3×6 mm. Stone analysis determined a calcium oxalate stone. 24 hour urinalysis through Litholink provided the following:
    Volume- 4.31
    SS CaOx- 3.66
    CA 24- 231
    Ox 24- 45
    Cit 24- 1005
    SS CaP- .54
    pH- 6.569
    Ss UA- .07
    UA 24- .421

    Hopefully that’s enough of the values for you to give me your thoughts. My urologist has recommended shock wave lithotripsy for the larger stone in my right kidney as he thinks it is too large to pass. I’m hesitant. I don’t like the idea of general anesthesia. I’ve already had surgeries to remove my appendix and gallbladder. I’m also afraid of damage to the kidney. In addition, I have Celiac disease and Hashimotos and have been gluten free for just over 2 years.

    I would really appreciate your insight on how to proceed.

    Thank you!

    Reply
    • Fredric Coe, MD

      Hi Hulda, with your 4.3 liters of urine volume you have little immediate stone risk – your SS values are low, including that for CaOx. But perhaps that volume is not a constant feature of your real life. You have a moderately high urine calcium, enough to raise stone risk, and a hefty urine oxalate. Perhaps your diet is low in calcium and raising your urine oxalate; perhaps your diet oxalate intake is high. I do not see our urine sodium, perhaps it is high (above 100 mEq daily and could be lowered. You have a malabsorption state, and this can raise urine oxalate. These are all ideas for your physician and you to think about. Ideally your diet will have 1000 mg of calcium – with meals, oxalate intake is kept low, and sodium likewise to keep urine calcium low. As for the stones, perhaps flexible ureteroscopy would be better than SWL given a lot of stones. Because I do not really know your clinical situation, there are a lot of ‘perhaps’ but you know, and can fill in the blanks. Regards, Fred Coe

      Reply
      • Hulda Smith

        Hi Dr Coe,

        Thanks so much for your response!

        My sodium was at 78 and that urine output is constant. I drink a lot of water and some coffee. I was eating a low calcium diet as I was not able to tolerate dairy after my celiac diagnosis. I can tolerate it better now and have made that correction. I’m also reducing sodium. I was eating a lot of cashews and have cut them out completely.

        My Dr is only concerned about the large stones. The remaining are 1-2 mm and he feels I can pass them.

        I feel a bit stuck as to what to do. I’m a mother of 3, my youngest is 4 and we have a beach vacation scheduled at the end of the month. I’m hesitant to have any procdure done so close to our trip on case I have complications. My husband would like to have it taken care of before we go so as to avoid an incident while out of town.

        What are your thoughts on the likelihood of a 3×6 stone being able to pass. If I were your patient, knowing what you know, what would you recommend?

        Thank you again!

        Reply
        • Fredric Coe, MD

          Hi Hulda, I am glad you have reduced your oxalate intake and that you maintain a high fluid intake. Long term you will need calcium, at least 1000 mg daily for your bones, and there are ways to do that. Symptomless stones are not in any way an indication for surgery. Surgery is just that, and the stone may or may not pass or cause a need for an ER visit or even a surgery. But a surgery to preemptively avoid a stone event is a sure thing: Procedure, and all that is involved. Assuming there is no significant pain, obstruction, bleeding of consequence, or infection presumed to be in the stones, there is to me no need to do anything. If you were my patient and those were the facts that would be my suggestions. Regards, Fred Coe

          Reply
          • Hulda Smith

            Thank you so much for your insights…this has been very helpful!

            Reply
  11. John ONeill

    Dr. Coe,

    I had a GIST tumor in the antrum of my stomach which was approximately 5cm. It was benign, but the treatment for it included resection via a rouxen Y laproscopic surgery. I’ve recently read the following article from NIH (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4249680/) which, according to the beginning abstract shows a 25% increase in urinary oxalate, a 30% decrease in urinary citrate, and reduction in urine volume by half a liter. Can you tell me what supplements I might take which would counter the effects of these increases in oxalytes and decreased in citrates? Would a calcium citrate and a magnesium type supplement assist? What probiotics might you recommend for me? Nobody I’ve talked with has really given me decent information on how to combat the changes from my surgery. I’ve also asked for a 24 hour urine test from my urologist. I was diagnosed last week with a 3mm kidney stone, which I don’t believe has passed, but my CT scan showed no new stones, so I want to get my levels balanced as quickly as I am able. I have also increased my water intake to consistently higher levels. Any advice you have for me would be GREATLY appreciated! Also, thank you for your information! It is extremely informative!

    John J ONeill

    Reply
    • Fredric Coe, MD

      Hi John, It is indeed true that these procedures will increase urine oxalate, lower urine citrate and raise risk of kidney stones. The approach is as you said, obtain 24 hour urine testing, find out what abnormalities are present in your specific instance, and take steps to reverse them. The general averages from the paper you mention are not a guide to actual treatment for one person. The basic approach to prevention is always the same: Find out the crystals in your stones if you can, get 24 hour urine testing, measure the supersaturations in your urine with respect to the crystals in your stones, and lower them by half, whether with water, measures to lower urine oxalate, raise urine citrate or whatever seems best in your case. Regards, Fred Coe

      Reply
  12. Marc. T

    HI,
    I just got my litholink report back. SS CaOx at 9.46 and urine calcium 334, volume 1.6 liters, urine oxalate 35mg, ss CaP 1.74, citrate 991, ph 5.8, history of calcium oxalate stones. 6 over the past 20 years.
    I read some of the notes above but am a bit confused as to what is the suggested corrective course based on these results. I also have been taking 4,000 iu vitamin d daily for low vitamin d levels. any thoughts/advice would be greatly appreciated.
    Marc

    Reply
    • Fredric Coe, MD

      Hi Marc, Well, you have a very high urine calcium excretion, a low urine volume, a modest urine oxalate and very high SS with CaOx of over 9 and also high for CaP = you do not need much SS to crystallize CaP. The obvious move is to double the urine volume. The high urine calcium is presumably idiopathic, unless you have a systemic disease – your physician needs to be sure about that. Next, urine calcium is very sensitive to salt intake which is urine sodium excretion. Take a look at yours. If it is above 65 mEq daily (1500 mg of sodium) lower it as much as you can. LIkewise look at your protein intake (PCR); if it is above 1, lower it. Retest. IF SS remain high despite double the volume, low sodium and reasonable protein consider thiazide – from your physician. An alternative to thiazide would be potassium citrate. Let me know. Regards, Fred Coe

      Reply
      • Marc. T

        Thank you so much for the prompt response and amazing information. your web site and commitment to these issues is unbelievable. other info from litholink that you mention above. “Our records do not show the use of calcium supplements, confirm clinically as calcium supplements can cause hypercalcuria. High urine calcium cannot be ascribed to high sodium (98
        mmol/d) or protein intake (PCR = 0.9 g/kg/d). Our records do not report that thiazide has been prescribed. Consider use of thiazide. If prescribed recheck at 6 weeks. Monitor serum potassium as appropriate”

        Reply
        • Fredric Coe, MD

          Hi Marc, As you may know, I founded Litholink and sold it to LabCorp in 2006. The algorithms that generated the comment you quoted were programmed by me and John Asplin, so that may account for why my comments and the Litholink report tend to agree. If you have such high urine calcium with so low a sodium intake, I would be certain about primary hyperparathyriodism or other diseases. Were both your serum PTH and serum calcium = fasting – in the normal ranges?? Regards, Fred Coe

          Reply
          • Marc. T

            thx again.. i had blood labs about 2 weeks ago, fasting, my thyroid panel was tsh 1.59, t4 7.4 and t up 34.3. not sure i have ever had serum pth or serum calcium tested..

            Reply
            • Fredric Coe, MD

              Hi Marc, I am sure you have; just enquire and be sure it was fasting. Your urine calcium is quite high for such a modest sodium intake, and if there is something more it is important for your physicians to know about it and get you the best possible treatment. Regards, Fred Coe

              Reply
              • Marc T.

                Hi Dr. Coe.
                I just checked and both fasting serum calcium is 9.5 and PTH was 82.

              • Fredric Coe, MD

                Hi Marc, The high PTH with normal calcium is common with low calcium diet or reduced serum 25 vitamin D. It is not a sign of primary hyperparathyroidism. Regards, Fred Coe

  13. Carla

    Dear Dr. Coe,
    Thank you for this article. I will be using this as a guide when I get my next 24 hour urine report. It is concise and to the point. Very readable. I truly appreciate you sharing all of your valuable information and research. This website is definitely one of a kind, and I am so glad to have discovered it. It is apparent in every article that you write that you both understand and care about your readers and the plight of the kidney stone patient. I have yet to find a doctor in my area that makes me feel like there is any kind of treatment besides ‘drink water and hope for the best.’ However, I am seeing a new nephrologist who is the head of the kidney stone prevention center at UCLA tomorrow morning and will be bringing a copy of your article “How to be a Successful Kidney Stone Patient” with the treatment cycle highlighted and ready to share. You have provided me with the knowledge and confidence to be more proactive as I seek help.
    Again, thank you!

    Reply
  14. Robert H. Howard

    I have never seen a lab report.
    I have never had any symptoms that I know of.
    I am trying to follow the high calcium diet including 500gm of calcium (TUMS) with each meal.

    Reply
  15. Jeff Finesilver

    When recommending fluid intake, it would be useful to provide ounces as well as liters for those of us who have yet to internalize the metric system.

    Reply
  16. Kim Gallagher

    Excellent! Concise and easy to follow. Allows me to be more proactive with my doctor.

    Reply

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