Jill Harris has contributed many articles on diet to this site. Here she uses her vast experience from Litholink and her practice to offer help with one of the more onerous aspects of kidney stone prevention. Fred Coe
Why
You have a kidney stone episode and your doctor asks you to collect your urine for 24 hours. Why oh why is this being asked of you? Isn’t it dreadful enough that you just had a kidney stone?
The only way to find out WHY you are forming kidney stones is to complete a urine collection.
The test results will tell your doctor how saturated your urine is with stone making crystals.
The more saturated your urine is, the more likely you are to form new stones.
Some clients have come to me and said, “Why do I need to do a urine collection if the doctor removed my stone and had it analyzed?”
A stone analysis may tell you what type of stone you made, but there are many different reasons you may have made that type of stone.
Figuring out your prevention plan is very complicated, and without a urine collection it is nearly impossible.
>One Day or Two Day Collections?
When you do your first collections, the ones your treatment is going to be based on, it is wise to do two: Two 24 hour urine collections.
Before you start pulling your hair out, let me tell you why.
What you eat and drink during your collection is going to be represented by your test results. If you do your collection on your birthday, you may be celebrating, drinking, eating foods you don’t usually eat and this will not represent a “normal” day for you.
If you do two collections, your test results will show a better picture of what you are eating and drinking.
Sometimes I see a two day collection and the day to day results are so very different they enable me to ask some important questions. For example, “The sodium levels in your urine were very high on your first collection, did you go out to eat that day?”
When I worked at Litholink Corporation we would tell patients to collect their urine on a weekday and a weekend day.
We requested the collection be completed this way because typically what we eat during the week is not what we eat during the weekend.
This way the lab results would show the difference between eating and drinking habits and we could offer better treatment suggestions to the doctors on the lab report.
How
Always Drink and Eat Normally
Many patients don’t want to hear their doctor scold them for not drinking enough so when they do their urine collection they drink and drink and drink. This is not what they usually do. Some already know they were eating badly and made some big changes so their tests would look better.
Why am I going to call you out on this? Am I just a pain in the neck?
No.
Cheating on Your Collection Days Will Not Help
If you drink more than you usually do or eat differently than you usually do, your doctor will base your treatment plan on what you did for those days.
You want your treatment plan to be based on what you usually did when you formed stones so that changes you make will lessen your chances of making more stones.
Suppose you already know you should drink more water, and you do it during your collections. You never did it before, when your stones were forming. Your doctor sees that you’re drinking 4 liters of water a day (you wanted to impress him or her).
S/he will be impressed and assume that low fluids were not and will not be your problem.
But, maybe low fluids were your problem. You won’t know and neither will your doctor.
So what?
No one, including you, will make fluids a priority and you may well forget to keep showing off.
Then what?
Maybe nothing else was wrong except low fluids, and that was gone for the moment – when you did the tests.
Maybe the fluids have already fallen back to your original low levels.
Your doctor will not be able to offer you any help, or worse, may tell you something generic like “avoid all green, leafy vegetables”. I don’t want anyone avoiding green, leafy, veggies if they don’t have to.
I tell clients, “if you drink gin all day then please do that during the test”.
If you don’t drink much water, please do as you normally do.
Getting on the right treatment plan is imperative in preventing new stones from forming. The only way to get on the right treatment plan is to eat and drink as you normally do on the days you are collecting your urine.
Period.
Diet Changes Before Collection Begins
Some of you were told to change your diets before doing the urine collection and wind up doing the collection while on your new diet.
This will NOT help.
You want your results to show what you did while you were making stones. For the day(s) you are asked to collect your urine, eat as you did before you knew you had a kidney stone.
Then go back to doing what your doctor told you to do or what s/he tells you to do after the test results are available.
Don’t Collect During Holidays
Many people will want to do their collection on the holiday because they are off work. If you are like me, you eat differently on holidays than you do on non-holidays.
Thanksgiving is not representative of how you normally eat, so this is not the time to do your collection.
Remember, since your results will show what you ate for that particular day, a treatment plan based on holidays will not be useful to you. Your doctor may tell you to go on certain diets that you do NOT have to go on.
That would not be helpful at all!
Make Time to do the Urine Collections
I completely understand that doing a urine collection is a total pain in the neck. It is annoying and nothing you want to do.
BUT.
There is nothing quite as bad as having a stone attack. If you have to weigh one against the other, doing a urine collection is the clear winner.
Find the time. It’s worth it.
Occupation Need Not be a Barrier
I have had pilots, truck drivers, surgeons, salespeople, and teachers all find the time and make collections while at work. Whether or not it is possible depends on a lot of circumstances, but doing it on the job is the ideal for one of your two days.
Some of you will not be able to bring the collection jug to work.
Perhaps you might have to take a day off from work.
If you do take a day off from work, please drink and eat as you normally would on a work day.
If you do a two-day collection, remember to do one on a weekend so your doctor can see how it differs from a weekday.
Questions About Your Collection
Once you receive your urine collection, please read all instructions on how to complete it.
If you have any questions, call the place of business you received your supplies from and ask them all the questions you may have before starting the collection.
It is dreadful when you have to re-do a collection because you didn’t do it the way they wanted you to.
Follow-up Collections
Once you do your initial 48-hour urine collection, the doctor will go over the results with you.
From those results, you will be told to do certain things that will help prevent stones in the future. You may be told to go on medications, drink more water, change your diet, or all three.
Four to six weeks after you have incorporated all the changes your doctor has prescribed for you, your doctor SHOULD ask you to do a 24-hour urine collection to make sure those changes are working for you.
If you don’t do a follow-up, how will you know if your treatment plan is working?
If your doctor doesn’t order a follow-up, ask for it.
You should expect your doctor will contact you about your results and make whatever changes are needed to get you the best possible prevention.
Annual 24-Hour Collections
Our urine chemistries change over time. It is prudent that you complete a yearly collection to ensure your treatment plan is still working for you.
Partly urine chemistries change because we are getting older, or have developed some new disease condition.
Diets change even if we are unaware of the changes because they occur slowly.
We gain or lose weight which can affect urine chemistries.
Our habits change: We give up or get a health club membership, or start running.
A Final Thought from Jill
Clearly now, you can see how important it is to complete urine collections.
I want you to know that I don’t ask you to see the importance of doing these darn collections without having compassion and empathy that you have to do them.
I know they are not convenient, nor are they fun.
Just keep in mind that if you don’t complete a urine collection, you will not know why you formed stones and will most likely keep right on forming them. I want to keep you away from that scenario.
Prevention is always our best defense. Completing your collections is a pretty benign way to keep stones at bay.
After collecting the 24 hrs urine test. How long can the specimen wait before we send it to lab corp?
What if it takes more then 24hrs after the collection will that change the urine chemistry in the sample?
Thanks
Dear Henry, I do not know anything about LabCorp procedures but I do know that Litholink needs samples back within 4 days or some of the measurements in the sample will have changed. I know this because at one time I owned Litholink and we made a study of the matter. To be certain I would send it back promptly. Best, Fred Coe
Nice explanation. Thank you.
Thank you very mch for saying so. Regards, Fred Coe
What is the importance of the stop time for a 24 hr urine and what if this is not properly recorded or provided later as an estimation?
Hi, A great question. The samples are calibrated for 24 hours. The clock starts when you empty your bladder, discard the urine, and write down the time. All the urine produced from then on will be collected. As close as possible to 24 hours later you empty your bladder, put that urine into the container, and write down the time – the stop time. The time difference between the start and stop is taken as the clock time -in hours – over which you collected. All excretion rates are calculated by dividing the amount of – as an example – calcium in the total urine volume by the hours between the start and stop time. So the stop time is crucial for calculating all excretion rates. Without it, no calculation. With an error in it, the excretion rates are in error and will be misleading. Regards, Fred Coe
How long does it take for a lab to generate the results from a Super Saturation Urine Test?
Hi Rhonda, To calculate supersaturation requires a full set of stone related analytes, so the time to reporting is the same as that for the report itself. A common turnaround time for commercial labs is 24 hours from receipt. Regards, Fred Coe
greetings, jill i am shaik i have an operation last 14 april 2014, and now i am having a creatine level of 1.5 in my urine i am not taking any medicine and is only drinking 3 ltrs of water daily in 24 hours is it enough of should increase the quantity.please advice.
Hi Shaik, Your question is puzzling. If you mean the amount of creatinine in your urine, and the 1.5 refers to amount per day, the amount of urine creatinine reflects your muscle mass. Your muscles produce a fixed amount of creatinine per minute, and in a full 24 hour collection you will have the same amount each day. The measurement is intended to be sure of completeness of the collection and that is the reason it is made. The materials in your urine that affect stones are such as calcium, oxalate, citrate, pH, urine volume itself, and others, but not creatinine, YOur physician is the one who needs to interpret these measurements for you and plan a proper treatment. Regards, Fred Coe
I’ve been having kidney stones for 19 months. My primary doctor finally sent me to a urologist. My main concern is I have 9 cyst’s on my left kidney and I have lesions on my right. I’m really scared at this point. Should I be nervous? I’m doing the 24 hr urine test now. Also doing blood work and ultra sound this week. Feeling real scared.
Hi Tina, The analysis of cysts by radiographs and ultrasound is a highly clinical matter and your physicians will have to sort out what it is. It sounds like some simple cysts, but I am at a great distance from your clinical reality and it is up to your physicians to let you know. As for the stones, the evaluation will help in planning prevention. In case you have not seen it, here is a good guide through the process. Regards, Fred Coe
jiill please answer my question i have a lot of questions and tension also.
hi jill are there any medicines that lower down my creatine levels please suggest some medicine that i should take or just water.
Hi Shaik, If you mean your serum creatinine, which is a measure of your kidney function, the question is very complex. Water is not an option. Reduced kidney function is a serious problem, and medication use likewise. Is it in fact your serum creatinine level you are speaking about? PLease let me know and I will try to be helpful. I suspect from the chain of questions that you are referring to your urine creatinine and I have answered that question. Regards, Fred Coe
What exactly are they screening for in a 24hr urine analysis?
Hi Sarah, A very important question. Take a look at this article, and see if it leads in a useful direction. If not, write back and I will try harder. Regards, Fred Coe
Hi.
I had passed a stone 3 weeks ago and still have one more in my kidney. Not moving yet.
I will have check up again in 6 months w/doctor but mean while i’m supposed to do 48 hr collection. They told me it takes 3 months for them to do test and get results. So I can do my collection in the next 3 months any time is convinient as it will not make the diferance in results while they advised me to drink more water and have some general changes in eating. By reading your article (which makes a lot of sence) i see it is oposite of what the doctor gave me as instructions. (?) Should i do collections now before new changes take effect (it would make sence)? Is it realy possible that testing and gettingbresults takes 3 months and how are they storing it for such a long time? If they already have found another stone in my kidney, why is my check up so far in 6 months? Is it dangerous, i mean the stone can move any time from now on? Oh, the pain 🙁
Thx
Hi Sandra,
Sorry to hear about your stone trouble. They are a nasty beast the reason we are so committed to this website and to prevention in general. No it doesn’t take 3 months. If you are doing a Litholink test (or any 24/48 hour urine collection), it will take a few days to have the labs run and completed once they receive your specimens. Could be the doc meant that it will take 3 months for you to get and appt and see him/her.
It is best to do the collection (if this is the first one you have ever done) and eat and drink as you normally would. This way you can see how your eating and drinking habits before you got the stone may have caused it. Also important is to do the collection when you are feeling ok. If you are in pain then you will not be eating and drinking normally.
If the other stone is in a secure place and is not moving the doc may say come back in 6 months and see where you and your stone stand. Has it moved? Has it grown? He/she will mostly likely order a scan so that they can keep an eye on it. I would do the collection soon, when you feel up to it. How did they give you prevention when you have not done a collection. That is the reason to do the urine collection. Until then, we don’t know why your are forming stones and changing your diet may or may not help. Don’t know for sure.
It is always a good idea to increase fluid intake. So that is fine, but anything else should wait until results are in and final. If you do drink lots more water during the collection be sure to tell doc that those values represent an increase in water intake since you last talked.
Hope this helps.
Jill
I have a 3-4mm stone which a CT confirmed. I then had a follow up 3 months later with an X-ray and an ultrasound, but neither showed that the stone was still there. I had no symptoms during this 3-4 month time period, but then a few days ago I had the immense pain from the kidney stone.
After the Ultrasound came back negative they wanted to do a bloodtest and urine collection. Is that still necessary since the stone is still inside me?
Hi LH, I would do whatever your physicians say as it is unclear where that stone is and what it is doing. The x ray and ultrasound may not be able to visualize the stone, it may be there. Your physicians need to manage this. Good luck, Regards, Fred Coe
I’m hoping that the urine testing in doing this weekend will help me prevent the gigantic stones I seem to form! Most recent was over 35mm sitting atop a bed of gravel and is the second one I’ve had of similar size in less than 10 years.
Having to go through having a nephrostomy and PCNL is no fun 🙁
Hi Abby, Be sure those stones passed or removed are analysed so you know what they are. And it is time to be sure you are getting the kind of prevention to prevent more such in the future. Here are a few good places to check. Regards, Fred Coe
Thanks Dr Coe. Most recent analysis showed 90% something apatite I think, but previous stones were mostly calcium oxylate so I have been on a prevention plan for many years. A small stone in my left kidney (showed about 6 months after a PCNL in 2008) was stable in the upper pole for 2 years so I was instructed see the urologist on an as needed basis. I had no symptoms until a few months ago and by the time it was discovered, it was a chore getting it out of there!
Hoping the 24hr study gives some insight! Thanks again!
Hi Abby, The analysis means you are forming calcium phosphate stones as well as calcium oxalate stones, a not rare outcome. Usually this conversion to CaP comes with time, sometimes shock wave treatments. Your physician should take a very close look at your urine chemistries and be sure that both the calcium oxalate and calcium phosphate supersaturations are very low. Regards, Fred Coe
Can you drink alcohol while testing? At least on one of the days.
HI Reece, It is not ideal to do so above your usual. If you drink a certain amount every day, just keep things that way. But do not drink on your collection days more than you usually would. The purpose of testing is to get a sense of your usual behavior. Regards, Fred Coe
Question: I need to do the 24 hour urine collection. However, I stop taking my cholestrol medication – I read that one of its side effects is kidney stones. I’ve never had kidney stones in my entire life ( 52years) the only thing different is the cholestrol medication my doctor perscribed- livalo I’ve been on it for 7 months. Should I start taking it again then do the urine collection. I stopped the medication for about a month now. My stone was removed two months ago. I just wasnt sure if the urine test would show that it is the medication that is causing my stone or not.
Any information you can share would be helpful. I just don’t want anymore kidney stones.
Hi Chana, I know of no reason your urine testing requires you stop your statin. But if you did stop go ahead and test. I have not as yet encountered statins as a cause of stones but am always glad to learn. Regards, Fred Coe
I have both calcium oxylate and Uris acid stones. My urologist has not ordered a 24 hour urine test. After talking to 2 urologists in the emergency room they were very surprised by this I am requesting one as soon as possble. I had a 1.2 cm kidney stone removed by lithotripsy and a 9mm removed at the same time I seem to be growing them rapidly. Am I correct in requesting the 24 hour urine test ?
Hi Lauren,
Let me put it this way. If you came into the er with pains in your stomach wouldn’t they want to do some testing to see what the problem was? Same for stones. If you have them you need to figure out why. And for goodness sake why would you wait for anymore stones to occur before doing the test? Let’s prevent them before that happens. The only way to start prevention is to see why. The urine collection will do just that. Good for you for asking for it!
Do it!
Jill
Any ideas why I would have chronic recurring calcium phosphate stones (5-10mm size), when my 24 hour urine collection results just came back as normal? None of my levels are elevated. I’ve had 6 ESL surgeries, plus a laser / needed stent surgery. Not a soda drinker, no family history. Stumped. Thanks,
Hi Jessica, Calcium phosphate stones can be a real problem. I doubt your results are uninformative; so called normal limits are not so easy to set for 24 hour urines. Take a look at this article on how to read your results and see if there are clues. Be sure your blood tests are all normal – especially serum calcium. Worst case, if you want to put up your results I could look. Regards, Fred Coe
How high is too high? Just got a result from 24 hr urine calcium of 1,665 mg/(24.h). Tested due to hyperparathyroidism. Should I be concerned?
Hi James, That is indeed so high as to make one think about errors. I presume you have primary hyperparathyroidism, from your comment, and that your physicians plan to cure it surgically. After such a cure be sure to check again that the urine calcium has fallen to a more normal value. As for concern, PHPT is best cured sooner than later and in your case sooner. But your physicians know this. Regards, Fred Coe
I had a hysterectomy 5 years ago for early stage node negative breast cancer. I am 49. I currently take Arimidex. My prognosis was 4% risk of recurrence. Since my surgery (not before) my calcium lives at 9.7-10.2. My Albumin lives at 4.7-5.0. Four years ago a routine CT Scan showed two stones. I have them followed annually by ultrasound. This month, my doctor decided to do a 24 Urine as the stone grew a little. My 24 urine was 452, which I understand is elevated. My question with this test is how high is 452? Another question is does lack of estrogen raise urine in calcium and affect urine results?
Hi Kris, Indeed a urine calcium of 452 mg is very high, enough to cause calcium stones. Lack of estrogen can raise urine calcium because bone mineral is lost easily and perhaps because of changes in kidney tubule cell calcium conservation. You should take steps to lower the urine calcium and protect your bones. At least, very low sodium diet and high calcium diet together would be helpful. Possibly a thiazide medication in addition – not instead of. This is pretty complex because of your estrogen status so take my comments as something perhaps your physicians might want to consider. They may want to use a bone oriented drug, as well. Regards, Fred Coe
I take Urocit K. My doc said that taking it during my urine test will not affect my results, is it okay to take Urocit while do ing the 24 hour test? Or, will taking any of my vitamins Vitamin D3, Prenatal, probiotic, krill oil, and sometimes Biotin affect the results?
What if for the past three weeks I’ve completely changed my diet for the better. Do I need to go back to my old ways for 24 hours when I’m planning on sticking to my new healthy eating habits?
Thank you!
Hi Mandy, The purpose of the test seems to be follow up to see how well your treatment is going. So do your new diet and your medication for the test. As for the other stuff, if you use it all the time, use it for your tests, too. Regards, Fred Coe
What happens if I get my period while doing the collection? Can I still collect the urine?
Hi Anon, go ahead, it makes no difference. Regards, Fred Coe
Hi-
Yes!
Jill
Hi,
When you are doing a 24 hour urine collection, does the urine need to be refrigerated during the collection period and/ or after the collection period, before it is returned to the lab?
If no refrigeration is required, how much time can the urine be kept outside, before returning it to the lab?
Thanks
Hi Nihal,
You must ask the company who you got it from and they will tell you. If this is from Litholink, you do NOT refrigerate it. Don’t worry about it being outside. It is fine.
Best, Jill
I have a 24 hour urine that starts in the morning. Is it best to not have any alcohol, like wine before the test?
Hi Reese, It is best to do what you usually do so the sample will represent your real life. regards, Fred Coe
Reese,
If you normally drink alcohol, then it is fine. If this is something you don’t usually do then save it for after the test. You want to see what a normal eating and drinking day looks like on your report.
Best,
Jill
So I started my one day collection the night before on accident… Will this affect my results?
Hi Kara,
You must collect for a 24 hour period. When you start that 24 hour period is up to you.
Hope this helps-
Jill
Hi Im doing a 24 hour urine collection (catecholamines, metanephines, vma, hva and 5hiaa) but i drank diet coke, can i still collect my urine?
Hi Maria, A reliable site does not mention diet coke for this test. So I assume you are alright. Regards, Fred Coe
I’m doing the 24 hour pee test if I have cancer or a stone will they find it. I’am a smoker that’s the only bad thing I do besides drink coffee and tea. there telling me not to have anything like that while i’m doing my test so will smoking screw up my test.
Hi Kim, urine testing will not identify cancer unless it involves special cytology. Smoking is not an issue. Cancer is detected with other means than 24 hour urine collections. Regards, Fred Coe
Hello. ..
I’m suffering of uti on and off for 8 months if not mistaken…. drinking water, antibiotics didn’t di much work. … a couple of doctors discovered I have deposits mostly on right kidney by ultrasound. .. and I think the right ureter is inflamed but I don’t know since it hurts often in one point above ovary it might be a stone. . it’s frustrating to live in pain with not much of offering a solution (drink water take a few pills and you’ll be fine. … not really my reality)
anyway I’m going to do a few tests and this 24 urine test as I read will help with my condition. .. so please can you help in my case what elements need to be checked such as calcuim uric acid etc
Hi Don, the combination of infections with inflammation and deposits suggests you may be colonized with bacteria that can produce stones made of struvite. Your physicians can tell if that is true. 24 hour urine testing will hardly help here, what is needed is to determine what those deposits are. You may not even have stones. Perhaps a CT scan would help. Unfortunately I cannot do much more at this distance, and hope your physicians can answer these questions for you. Regards, Fred Coe
Hello I’m an 18 year old female, I’ve recently went to my urologist with 6 stones in the right kidney and 5 in the left. I’ve had kidney stones since I was 13. My urologist did a comprehensive metabolic panel and PTH test and that all came back normal but I have to do a 24 hour urine test. What would be shown in the urine that wouldn’t be in the blood? Thanks
Hi Kearstin, The blood tests are fine but most of the findings are in the urine. Given your story and stone numbers I would guess you have high urine calcium of genetic origin. Here is an approach to evaluation and prevention. Yes – the urine testing is paramount. Regards, Fred Coe
Is this also used by employers for drug screening?
Hi Irene,
No, this is not used for drug screening. When you test urine for drugs it is a “pee in a cup type of thing”. A urine collection for kidney stone work up is collecting your urine for 24 hours.
Jill
Hi my 14 month old has just completed 3x 24 hour urine collections using a catheter and drain inher kidney. I changed her nappy once a day and noticed the nappy was slightly damp like the catheter may have leaked a tiny bit. She is only a baby so its nearly impossible to get every drop but im sure we got 99% of it. Will this make a huge difference to the results? I dont want to make her do it all over again. She was super uncomfortable 🙁
Hi Zara, It will do fine. Results for infants are normalized against urine creatinine concentration to allow for such errors. Best, Fred Coe
Hey I was wondering if marijuana will show up on the results from the 24 hour urine collecting?
Hi Johnathan, I do not know. No one tests these panels for drugs, so it would not be found in the course of stone testing. I suppose if someone wanted to look they might find it. Regards, Fred Coe
I am waiting for my 24 hr urine collection kit from Litholink. Went to my PCP this morning and it looks like I have a UTI. Awaiting lab results and hope to have them in 48 hours. Do I have to wait now to do my 24 hour urine test till after the antibiotics are done? I want the best results of course! Also, my blood serum shows that I have high uric acid (8.3). Do I also wait till after the urine collection to drink lemon in my water? If I understand correctly, I should eat like I used to eat before the stones (gone now litho July 2017). A nice spinach salad?
Hi Janene, I would wait. Don’t make changes now, wait for the test results to avoid confusion. Why would anyone drink lemon anyway unless their urine was low in citrate. Even then there are better ways. Regards, Fred Coe
Hi,
My doctor did a 24h urine test which comprised of Creatinine, Sodium, Potassium, Urate and Calcium.
Which other tests should ideally be done for a calcium oxalate stone former or stone former in general
to cover all areas?
Also, I’m now drinking a lot more, as before I was drinking very little , even when exercising intensely
which is probably the cause of my stones. When doing the collection should you drink the same volume
as you used to drink previously, which in my case is very little? I don’t want to start the creation of another stone
even if just for 24h…
Thanks
Ray
Hi Ray, Common vendors provide many more measurements so as to calculate supersaturations. So I would not be satisfied. I would have two minds about the conditions of collection. Do as you did if you want to know what might have caused stones; do as you do now if you want to know about residual problems. Regards, Fred Coe
Excellent, very useful link. Thanks!
Hello Dr. Coe and Jill Harris,
What a wonderful web site! Thank you for sharing all this information!! It is all very helpful. I do have a few questions. First, some background: I have a history of idiopathic hematuria (checked out about 7 or 8 years ago), many UTIs (which I self-treat these days with D’Mannose and probiotics to avoid antibiotics–quite successfully). I also have a history (probably irrelevant) of nephritis as a 4-year old. Additionally, I was diagnosed with vulvodynia in 1997 and had my urine tested at the time and had a high oxalate level. I’m now 62. Despite my 2001 diagnosis of CLLeukemia, I’m still at stage zero and generally in good health with all my “healthy eating” and supplements.
But now I’m dealing with 4+ RBC in my urine, and on reflection I realize I’ve been eating way too many oxalates, as for years now it didn’t seem to matter (little or no pain). Fast forward to the present. Could calcium oxalate crystals be irritating my bladder or urethra enough to cause micrscopic bleeding? I have had an uptick of pain, particularly after urination, with no infection. This morning I had a kidney and bladder ultrasound at a urologist’s office, and the technician said that while I have to wait for the radiology report (two weeks), she didn’t see any stones. I’ve already changed up my diet to reduce oxalates and the mild vulvodynia pain has somewhat subsided. (I was eating whole orange and lemons –with skin– as well as raspberries, nuts, homemade bone broth soup, homemade fermented vegetables, Swiss chard, spinach, and lots and lots of carob.) My question: Do you think I would benefit from a 24-hour urine collection? Do I need to get that ordered from a doctor? And most of all, could crystals be the cause of the bleeding? Do you offer phone consultations? I can be contacted at cllalternatives @ gmail.com (no spaces). Again, thank you for your wonderful site! – Denise
Hi Denise, crystals can cause pain and bleeding. A good way to look is through a microscope – your physician can do this or have it done – on morning samples. To look is very inexpensive, and if crystals go with the blood you have the beginnings of an answer. Another is 24 hour urine looking at calcium, oxalate, and all other crystallization potentials. Oxalate alone is unlikely as a cause. Unexplained bleeding will inevitably require a diagnostic evaluation beyond ultrasound. Your urologists knows this. My university has not as yet set up formal telemedicine, so I cannot actually offer proper consultation at this time. Sorry. Regards, Fred Coe
I have pediatricians requesting stone formers profile on a random urine rather than a 24 hour urine. What is your recommendation on this?
Hi Yvonne, I know why but unless it is on infants I would try to get a real collection. The cost is the same, the information a lot better. When I owned Litholink we performed a large number of 24 hour urines on kids and the company – no part of LabCorp – still does, so it is not a big deal. Regards, Fred
I am doing a 24 hour collection tomorrow because of erratic parathyroid levels and the incidental finding of kidney stones during a scan of my pancreas. This may seem silly, but I would like to make a special occasion dinner that involves boiling a bottle of red wine down to about 2 cups before simmering with the chicken for 2 hours. Does alcohol really burn off? I was told to avoid alcohol and calcium supplements during the test.
Hi Paula, The chicken sounds delicious. Perhaps you might want to collect your 24 hour sample eating a diet more like your usual one, although from the ambitious plan you are perhaps commonly a fine chef. The alcohol is volatile and much will distill off. Be sure your blood for PTH includes a calcium measurement and is fasting. Regards, Fred Coe
I am trying to donate a kidney for a loved one and have a 7 mm stone. I really want to pass the 24 hour urine test. I don’t want to consume anything that might give bad results. How can I optimize my results? I have zero history of stones in myself of in my family.
Hi CHris, donation of kidneys by stone formers is a special issue. The transplant center you work with will have a protocol to evaluate your suitability. I would advise you collect the 24 hour urine eating and drinking as you usually do. Special changes you make could make your results look more abnormal! If you indeed have stone forming abnormalities, let your physicians advise you; they have proper skills and work by protocols designed to protect you and your intended recipient. Regards, Fred Coe
Does still having a stone in the kidney affect the amount of calcium seen on the 24-hour urine? I had one large calcium oxalate stone removed from the ureter but have another good sized stone in the other kidney that I’m trying to put off treating for a little bit if I can. I don’t want it to grow larger in the meantime, and so had the 24-hr urine done. Ca was 399mg/24hrs, Oxalate was 48mg, and Uric Acid was 876mg. Total volume 2.1L. Wondering if having that stone sitting up there is influencing the urine readings, or if that’s still all coming through the kidneys?
Hi Jack, No, not at all. You have hypercalciuria and need treatment for it. The link is general, but I presume it is idiopathic hypercalciuria – links to that are in the first article. Be sure and treat it as written. Regards, Fred Coe
What piece is missing?
I have been followed since May 2017 for consistent elevated levels of protein, albumin/creatinine, erythrocytes, leukocytes. No CT scan. Only ultrasound showing embedded stone and cysts. My last 24 hour collection specimen volume was 0.70 L/day, 9.6 mmol/L creatinine, 6.7 mmol/day (24 hour urine), protein 0.42 g/L, 0.29 g/day (24 hour urine). I am somewhat perplexed. Nephrologist also seems unconcerned but I am. I see a kidney internist next, hoping to get more answers. What should I be asking for? Diet next steps? Water intake goals? I feel like I am stuck in some kind of freaky kidney time warp paralyzed not knowing what’s causing this and waiting on standby hoping for a clear diagnosis and treatment plan.
Love from Canada! BJ
Hi Barb, Your urine volume is scanty given you form stones. I calculate you have about 380 mg/gm creatinine of urine protein, which is a bit elevated. But if there is blood in the urine, that protein may be because of bleeding not intrinsic renal disease. So perhaps your problem is stones, bleeding, consequent urine protein increase, and the real issue is stone prevention. Of course I do not know your serum creatinine so I cannot judge your kidney function. About your stones I can say little except so remarkably low a urine volume confers considerable stone risk. Regards, Fred Coe
Hi Barb, Your urine volume is scanty given you form stones. I calculate you have about 380 mg/gm creatinine of urine protein, which is a bit elevated. But if there is blood in the urine, that protein may be because of bleeding not intrinsic renal disease. So perhaps your problem is stones, bleeding, consequent urine protein increase, and the real issue is stone prevention. Of course I do not know your serum creatinine so I cannot judge your kidney function. About your stones I can say little except so remarkably low a urine volume confers considerable stone risk. Regards, Fred Coe
I am trying to figure out what it is ment by supersaturation, urine, abnormal.
Hi Andrea, You are a sharp reader. Up to now, we have not had good links between SS and stone risk. So we always use a paradigm: In a person actively producing kidney stones, the urine SS with respect to the crystals in the stones is too high; reduce it. For uric acid as a special case, any SS above 1 is a risk and we need to lower it below 1. Recently we have new findings that actually give stone risk for a given level of SS and I mean to publish this as soon as I am able. Regards, Fred Coe
Hi Dr. Coe and Jill Harris,
The morning of my 24 hr test I called the nurse to check on whether or not to drink lots of water during the test. She advised I drink “at least” 64 oz. I mentioned the Dr. said not to alter my normal pattern and eat everything as usual, so I thought maybe I should only drink my normal amount which is not nearly that much. I followed her advice and now I feel like my results are not accurate. My urine volume was 3,200 mL, way more than my normal daily output.
Yes, I did toss the first pee of the day.
Also, the test results only showed Calcium, Phosphorus and Uric acid. Your article reads like there should be more things checked.
Thanks, Margie
CalciumTimed Urine 3.2 mg/dL, Calcium Urine Excretion 102 mg/D
Phosphorus Timed Urine 14.3 mg/dL, Phosphorus Urine Excretion 0.5 g/D
Urid Acid Timed Urine 15.1 mg/dL, Uric Acid Excretion 483 mg/D
Hi Margie, Usually physicians order a panel of tests that give more information for a bargain price. But the calcium is low as I noted below and the other two tests add nothing special. Regards, Fred Coe
Hi Margie, As I wrote in my other reply, your urine calcium is low normal, the other two measurements of marginal value and not abnormal. Commercial vendors offer a comprehensive panel that is more informative. Regards, Fred Coe
Hello. Glad to have found this website, very informative and helpful.
I had my first kidney stone beginning of this year (4mm), never tested the stone back then as thought it was a one off and knew very little regarding stones. After researching I cut down on oxalate foods hoping that was the cause. 5 months later I had another attack and ultrasound showed 9x6mm stone stuck in lower ureter, 3 months has passed and the stone is still in ureter, I’ve had 3 ultrasounds and its slowly moving towards bladder (no pain), last ultrasound showing its right at entrance of bladder now.
How long can a stone remain in ureter tubes, is there a time limit? Is it ok to continue waiting if no pain or other complications? I had urine bacteria tests which show no infection. Can a 9mm stone be passed safely? Ultrasound shows the stone has slightly decreased in diameter and I’m hoping with urine being able to flow will help smooth stone or decrease size?
I’ve become more proactive trying to figure out why I developed 2 stones in 5 months, 37 year old male, never had issues before. Whether coincidence or not I had a stomach infection last year which took a couple months to recover. I often wonder if that triggered a change? I’ve had 3 blood calcium tests which were 10, 10.7, 10 mg/dL which are upper limit, so then tested parathyroid which was 35.69 pg/ml. I tried asking for a 24 hour urine test but being in Mexico its unavailable where I’m staying, they had a spot calcium urine test which I took in the morning fasted and result was 4.9 mg/2hr with the lab range of 4-18 mg/2hr. From reading this page I understand 24 hour testing is needed but can any opinion be made with my spot test fasted result?
Kind regards
Jay
Hi Jay, months of intestinal disease with diarrhea can indeed result in stones. The three borderline serum calcium results and normal PTH are consistent with primary hyperparathyroidism, and you need a 24 hour urine. Spot and fasting urines are useless. A 9 mm stone has low likelihood of passage and if in the ureter obstruction is always a concern because of renal damage. The ultrasound can diagnose obstruction, but after 3 months of waiting I would consider a CT that is far better. Even modest obstruction can damage kidneys. Perhaps your physicians may have reasons to omit such testing and they are responsible for your care and my opinion is simply that of an outsider. Regards, Fred Coe
Thanks Dr Coe.
I will try find a way to get a 24 hour urine test. I’m concerned with the calcium levels and will get a few more calcium/PTH tests to compare. I’ve heard taking vitamin K2 can help keep calcium in the bones, depending on PTH issues of course. Good to know stomach infections can result in stones, I definitely had malabsorption issues with fatty stools for a couple months, I feel fine now with no issues but have still yet to return to my normal weight. So I wonder if a little malabsorption remains or the infection altered my digestive tract.
Being in Mexico the urologist only offered Flomax, the language barrier doesn’t help either which is why I’ve taken matters into my own hands researching/testing. After reading studies on Flomax it offers little help, some studies show no difference in passing stones and I found one which helped pass larger stones by 20%. I’m hesitant to take it from the side effects but may have to consider it. What is your opinion on Flomax and Alpha Blockers?
Thanks again
Hi Jay, In general urologists favor it for stone passage; I have no special clinical experience one way or the other. Used rather short term, side effects matter little unless blood pressure falls too much. It is an alpha blocker. As for vitamin K, no trials, and based on a complex theory about mineral deposition; I cannot recommend it. Regards, Fred Coe
Dr. Coe, you had offered me the opportunity to share my labs with you in hopes of some insight as to what direction I might take. Hopefully, this is the correct place to add them?
Actions taken after the first sample: drastic reduction in nut intake (my weakness), consistent H2O intake of min. 3 liters daily, addition of 1000 mg of CA via supplementation, Na intake reduced. Historically, I am a Ca Ox stone builder.
I cannot adequately express my gratitude for your willingness to selflessly help others like myself suffering from kidney stones!
4/6/18 8/12/18
Vol 3.61 3.31
SSCaOx 4.21 3.0
Ca24 206 187
Ox24 44 28
Cit24 597 364
SSCaP .2 .06
pH 5.692 5.158
SSUA .96 1.58
UA24 .971 .762
Na 24 155 145
K24 65 54
Mg24 94 70
P24 .898 .730
Nh424 33 31
CL24 168 155
Sul24 37 38
UUN24 11.28 10.15
PCR 1.1 1.0
CR24 2187 1576
Cr24/Kg 27.6 19.9
Ca24/Cr24 94 119
Hi Michael, The two urines cannot be compared because the creatinine excretions vary between 2187 and 1576; because these reflect muscle mass, one of them is wrong – your muscle mass did not change that much in 4 months. Both show high urine volumes, the second one a very low pH – are you sure your stones do not contain uric acid?? – The oxalate did fall even if I adjust for the creatinine, but only from 44 to 38 (2187/1576 = 1.3 as a multiplier to bring the second urine to the first). Urine sodium thus adjusted rose, as did calcium, etc. So you need another 24 hour urine as a tie breaker, and be sure you collect it ideally. Regards, Fred Coe
Dr. Coe,
I have attached my most recent results after you suggested that the creatinine excretions were awry. It appears the first lab was not accurate, so only the most recent 2 are below.
On the lab from 4/6/18 (not shown) Urine Ca was 206 and I was directed to supplement with Ca, which I did 100mg/day. Now it appears the Ca is high Lab 2 (8/12/18) showed urine citrate of 364. I was directed to increase citrate, so now take lemon juice in my 3 liters of daily water intake. That appears to have improved. I would very much appreciate any guidance you may offer for dietary changes.
Again, a million thank you’s for your time and kindness!
Date: 8/12/2018 11/6/2018
Vol 3.31 3.24
SSCaOx 3.00 3.51
Ca24 187 236
Ox24 28 32
Cit24 364 724
SSCaP 0.06 0.40
pH 5.158 5.936
SSUA 1.58 0.53
UA24 0.762 0.731
Na 24 145 181
K24 54 57
Mg24 70 121
P24 0.73 0.836
Nh424 31 27
CL24 155 176
Sul24 38 31
UUN24 10.15 9.46
PCR 1.0 1.0
CR24 1576 1710
Cr24/Kg 19.9 22.2
Ca24/Cr24 119 138
Hi Michael, Note the sodium is higher in the urine with more sodium (145 181); higher sodium raises urine calcium loss; even allowing for urine creatinine, Ca/cr24 went up with urine sodium. Urine sodium is basically diet sodium integrated over several days. So the message is lower your diet sodium. A fair goal is below the tolerable upper limit for the US of 2300 mg/d – 100 mEq/d. The citrate went up, and perhaps the lemon juice did that. But lemon juice is bad for tooth enamel so you might want to use more fruits and veggies. I am suspicious of the lemon story anyway because the urine potassium did not go up and the citrate in lemon juice is potassium citrate. Likewise, your urine ammonia NH4 did not go up but went down as expected with a real diet alkali load from fruits but your acid load sul24 also went down and the changes are 7 sulfate and 4 nh4, so I see no lemon effect. Your urine because more alkaline, so something happened but I cannot see what it was. Altogether, less sodium would be good, as it will lower urine calcium more. Regards, Fred Coe
Dr. Coe, many thanks for your time and focus. I will digest this, and work on limiting sodium.
Mike
Thank you for an informative article. I am considering having a kidney stone analyzed and having a 24-hour urine test but am wondering about the costs. I can’t find any costs anywhere on the Internet. Can you give me a rough idea of the cost?
Hi John, Price in the US is strange. If you have Medicare, common commercial vendors – not hospitals! – should furnish the testing for about $200.00 per 24 hour urine. If not, everything depends on your insurance plan, but your out of pocket cost should be in about that same range more or less. For stone analysis, prices run a lot lower – perhaps $50.00 to the patient, and insurance usually pays most of it. These are my own observations, and who knows what charges can be from one place to another. Regards, Fred Coe
Hello. What is normal PH level should be in 24 hour urine collection? If 7 is neutral, should I strive it to be close to 7? Mine is 6.961. My second question is regarding Ca 24. Mine is 368. Does it mean I excrete too much calcium it and that is why I have osteoporosis? Thank you.
Hi Birute, The usual urine pH is 6; yours is high. Likewise your urine calcium. You may have idiopathic hypercalciuria, a cause of bone disease and stones, and need to be sure – your physicians do this – and treat it properly – high diet calcium, low diet sodium, meds if needed. Regards, Fred Coe
What happens if I miss 1 urine do I have to start all over again
Hi Laura,
For it to be a complete collection you should do it over, yes. Not what you want to do but you really want to get the full picture-
Best, Jill
Is it ok to have sex during a collection?
Hi Lynn,
It is fine to have sex while you are doing a 24-hour urine collection.
Jill
Thank you
My menstruation began the same day my urine test arrived. Should I wait for my period to end, or should I do the urine test as soon as possible?
Hi Melinda, it is reasonable to wait. Easier, too. Regards, Fred Coe
I am on macrobid for a bladder infection. Is it ok to do a 24 urine test on this antibiotic ?
Hi Moni,
I would wait until you took your full course of the antibiotic and then do your collection.
Best, Jill
At the time of my 24 hr collection I was actively trying to pass a stone,and did so 20 minutes after completion. I did have visible pinkish blood,and called both Litholink and my Dr prior to testing. They both said to commence with the test. During this time,I passed 3 stones(I collected 2),and one the size of a grain of sand(also collected)- all passed within a 6 day time frame. The nurse called to relay a summary of my results until I see the Dr later this week. I cannot access my exact numbers from Litholink until tomorrow,but I am very concerned that the Dr is now ordered blood work this week and every 3 months,along with another 24 hr collection in 4 weeks. Also new is my urine acid is now high. What causes uric acid rise? I eat very little meat,chciken,fish. I have a lot of inflammation in my knee for the past 1 1/2 months from a torn meniscus. Could this alter my uric acid levels? I am also concerned that I will now be doing regular blood work,instead of yearly.
Hi Elan, Good questions, but there is not enough information for me so say anything useful. The stones and blood will not affect the 24 hour urine values. The urine uric acid excretion follows purine intake – from cell nuclei so can come from eating animals or veggies like seeds where the amount of nuclei is high. Inflammation will not alter urine uric acid levels. You will want to have the stone analysed and evaluate your urine results in relation to the crystals in the stone. As for your blood work and tempo I can only assume there was some reason such as a number perhaps out of the normal range, but that is mere guessing on my part. Whatever, prevention follows a regular path. Here is a good summary. Regards, Fred Coe.
Is it better to have a high urine count of over 2500 or a very low one?
Hi Chris, I am not sure which count you mean – urine volume, perhaps. Can you say what count you are concerned with? Regards, Fred Coe
I am taking antibiotics for a UTI. Will this affect my 24 hr Urine capture?
Hi Paula, No it will not. Regards, Fred Coe