Jeff, a reader of this site, suggested this topic and I realized it was one that I should have written long ago.
You can make sense of all those numbers in the 24 hour kidney stone reports.
You can use those numbers to understand how things stand with you.
Reading the numbers can help you achieve your best possible chance at stone prevention – which is the only reason all those lab tests were done in the first place.
This article deals with calcium stones. A second one will cover uric acid stones.
Be Sure You Have Been Screened For Systemic Diseases
Your physician does this part. But even for systemic diseases stone risk is gauged in the urine so you can read along and assess how prevention is going.
Units of 24 hour Urine Measurements
Time
Because excretions of stone risk factors are in amount per 24 hours, we need the time of the collection. You provide the beginning and end times for the collection, in minutes and hours, and the laboratory corrects all excretion values to amounts in 24 hours.
For example, you start a urine collection at 7 am and complete it at 5 am the next morning. The measured total time is 22 hours. If the volume is 1.5 liters, the volume ‘corrected’ to 24 hours is 1.5 liters x 24 /22 (1.09) or 1.636 liters/24 hours.
It is obvious that the less ‘correcting’ the better, because the ‘correction’ assumes that every hour is the same as every other hour, which is not likely. So you want to collect as close to 24 hours as possible. If your time is below 22 or above 26 hours throw it away – no cost – and do another.
I am sure this is an unnecessary comment but sometimes people forget that a urine collection begins by emptying the bladder, writing down the time, and discarding the urine. Here and there people add it, making the real collection from whenever the bladder had last been emptied.
Volume per 24 Hours
Urine volume is measured in liters (L) or milliliters (ml). A milliliter is 1/1,000 of a liter, so there are 1,000 ml in a liter. One liter is 1.06 quarts. The laboratory measures the total volume of urine if you send or bring it. Often you will read the volume yourself, off of a collection container.
Because excretion rates like calcium, oxalate, citrate, and uric acid are calculated by multiplying their concentrations by the 24 hour volume, mistakes in timing, collection, or measurement of volume will make the results less valid. You provide the collection times, assure all the urine has been collected, and even may measure the volume, so quality is under your control.
Excretion Rates
Urine creatinine, calcium, oxalate, phosphate, and citrate excretions, are in milligrams (mg) or grams (gm) per 24 hours. A mg is 1/1,000 of a gram. An ounce contains 28.3 gm.
Urine sodium is measured in millimoles (mmol) or milliequivalents (mEq)/24 hours. Atoms, like sodium, each have a weight made up mainly of their constituent protons and neutrons. One mmol of sodium is 23 mg.
Some atoms like calcium have two charged sites which can bind to other molecules or atoms. They are often measured in milliequivalents (mEq) which is the weight times the number of sites. Sodium has only one, so mmol and mEq are the same.
Molecules like creatinine and oxalate have weights made up of their constituent atoms.
Conversion of Units
Some laboratories report in mmol or mEq. You can convert your lab report if it differs from mine. I will be using L for urine volume, mg for urine creatinine, calcium, oxalate, and citrate, and mmol for urine sodium. Here are the conversions:
Creatinine; 113 mg/mmol
Calcium: 40 mg/mmol; 20 mg/mEq
Sodium: 23 mg/mmol or mEq
Oxalate (oxalic acid): 88 mg/mmol; 44 mg/mEq
Citrate (citric acid): 189 mg/mmol
Direct Measurements
Acidity or alkalinity are measured in pH – no units. It is a logarithm to the base 10 so a change from 6 to 5 means a 10 fold increase in acidity, from 6 to 7 a ten fold increase in alkalinity.
Supersaturations are calculated from urine concentrations. The one we use here is the ratio of the concentration dissolved in urine of each of the three important stone forming salts, calcium oxalate, calcium phosphate, and uric acid divided by their individual solubilities at body temperature. Values below 1 mean crystals will dissolve. Values at one mean crystals will neither grow nor shrink nor form. Values above 1 mean crystals can form and grow. Being a ratio it has no units.
Is The 24 Hour Urine Valid?
Urine creatinine
Like all 24 hour excretion rates, that for creatinine is calculated from the concentration, measured volume, and collection time.
Because muscle cells make almost all the creatinine lost in urine any two urines you collect will have about the same amount of creatinine in them. A more than 20% variation between two urines suggests an error in one collection. If there are many collections, most creatinine excretions will line up pretty well, and an outlier – too high or low by more than 20% of the average for all the collections will stand out.
When a urine stands out as different from prior collections, I say it is best to repeat it. If there are two, use the one that seems more correct.
‘More correct’ is judged by expected amounts of urine creatinine. For men, one expects about 18 – 24 mg/kg body weight; for women, 16 – 22. A urine far out of those ranges is suspect. In people who have a high body fat percentage the ratio can be as low as 12 mg/kg/day, and people who have little body fat and a high muscle mass can be as high as 30 mg/kg/day.
Conditions of Collection
Did you eat and drink as usual, or show off? Had you ‘improved things’ since a recent stone so your collections reflect new habits and not those that led to the stones? Every collection is a one day frame out of a movie that is running 365 frames a year, so if these few days do not reliably represent your average life, their results will inevitably mislead you and your physicians and falsify what you came to do.
Reading the Results
Urine Volume
Curhan and colleagues have linked new onset of stones to urine volume in three large cohorts reviewed in our other articles. Take a look now. The graph is on page 2 of the article. Risk is on the vertical axis, and urine volume is on the horizontal axis. When red shows above the line at 1 it is above normal.
Risk is low above 2.25 liters/24 hours. But the day is long and the 24 hour urine is an average, so for insurance it is best to overshoot so the low times are still not too low. I would say 2.5 – 3 liters liters/24 hours is ideal.
Urine Calcium
Stone risk increases with urine calcium excretion above 200 mg/day in men and women – take a look. The calcium risk is at the upper left corner of the graph.
If you have above 200 mg/24 hours you have ‘hypercalciuria’, a high enough calcium to pose risk of stones – and also bone disease. There are many causes of hypercalciuria. The commonest is simply a genetic tendency, called idiopathic hypercalciuria. ‘Idiopathic’ means your physician has ruled out any of the other causes of hypercalciuria.
You lower urine calcium in idiopathic hypercalciuria with reduced diet sodium, avoidance of sugar loads, and medications if needed. You compare treated to untreated excretion to see how well the treatment worked.
Urine Sodium
Urine sodium is essentially the diet sodium intake. Because urine losses can lag intake when intake varies sharply, urine sodium is a good estimate of the average over 3 – 4 days. If you tried to lower your diet sodium to 100 mmol/24 hours, 2,300 mg intake, and you find 200 mmol/24 hours, you can be sure that your average intake is on average twice what you desired.
Suppose your urine calcium is 250 mg/24 hours, urine sodium 200 mmol/24 hours – twice the upper limit of diet sodium in the US and above the optimal value of 65 mmol (about 1,500 mg/24 hours). You would want to lower your diet sodium. Suppose your urine sodium was already 65 mmol/24 hours and urine calcium was 250 mg/24 hours; you would want to take other steps like thiazide diuretics or potassium citrate.
What if your urine calcium is 450 mg and your urine sodium is 200 mmol? Sounds like a bigger problem, but it is not. When urine calcium is higher the slope dependency of urine calcium on urine sodium is steeper, so the same reduction of sodium could bring urine calcium quite a way down.
If you lowered diet sodium and there is no change, do not assume the test is wrong. Check the creatinine values – do they match? If so, you have not lowered your average sodium intake. Sodium is an atom and you are not a cyclotron; you cannot make sodium or destroy it.
Sugar Loads
Given to people with idiopathic hypercalciuria they cause a rapid rise in urine calcium and supersaturation. The 24 hour urine will tend to underestimate this because of averaging throughout the day.
Thiazide Diuretics and Potassium Citrate
These drugs come after diet changes have not proven sufficient and are added to the diet changes.
Urine Oxalate
Stone risk increases with increasing urine oxalate and if the risk ratio is not as high as for calcium risk appears at very low levels of excretion – above 25 mg/day. In general, high urine oxalate comes from high oxalate diets, low calcium diets, or the combination of high oxalate and low calcium together. Therefore treatment is dietary. Excellent food lists are in this site – linked from the oxalate diet article. Rarely, urine oxalate is raised from a hereditary overproduction state – primary hyperoxaluria. Likewise, bowel diseases can raise urine oxalate. These are complex conditions and diet alone is rarely enough.
If urine oxalate is high and you have corrected both your diet oxalate intake and added significant diet calcium, you may have some form of genetic or acquired oxalate overproduction or an otherwise inapparent intestinal absorption problem.
Urine Citrate
Citrate is a powerful force against calcium stones. It binds calcium in a soluble complex. It interferes with calcium crystal formation and growth. Low urine citrate is a risk factor for new stone onset – bottom left panel of the graph. Above 400 mg daily there is no extra risk of stones in men or women, so ‘hypocitraturia’ means a urine citrate below 400 mg daily.
If you begin taking, as an example, four 10 mEq potassium citrate pills a day – 40 mEq, that extra 40 mEq of potassium should appear in the urine. If it is not there, the pills may not be delivering the medication into the blood from the bowel. The urine pH should rise because citrate imposes an alkali load. If it does not and the urine potassium does rise, you may need more of the medication.
Urine ammonia – I will cover this in the second half of this two part article – is a major way the body removes acid, so when you take citrate ammonia excretion should fall. If it does not fall, and urine potassium rises perhaps your pills are potassium chloride – the pharmacist switched from what was prescribed.
Strangely, the urine citrate itself does not rise in everyone even when potassium and pH rise and ammonia falls.
Urine pH
A low value – below 5.5 poses a risk of uric acid stones. A high value, above 6.2 raises calcium phosphate supersaturation and risk of calcium phosphate stones. Potassium citrate can raise urine pH; there are no medications to lower urine pH except methionine and ammonium chloride and these are not usable for stone prevention because they will increase urine calcium and pose a risk of bone mineral loss.
Urine Supersaturations
Get Them
If there are no supersaturations, ask that your samples be processed by a vendor that provides them. Supersaturation is the driving force for crystal formation and growth, and invaluable for monitoring stone prevention.
Relate Them To Your Stone Crystals
There will be three supersaturations: Calcium oxalate, calcium phosphate, and uric acid. Inspect the ones related to your stone crystals. For calcium oxalate both calcium oxalate and calcium phosphate supersaturations matter. If calcium phosphate, that one matters most. If pure uric acid, it is uric acid supersaturation.
Reduce Them
One should not compare values in a stone former to values in normal people, who often have urine supersaturations as high or higher than those of stone formers. Active stone formation means supersaturation is too high for you whatever the value may be and needs to be lower. You reduce your supersaturations by increasing urine volume and reducing excretions of calcium and oxalate, or raising excretion of citrate without undue increase of urine pH. That is why we make these measurements.
Compare Then to Now
Compare you now to you before your most recent fluid and diet intakes or medications: If they have fallen, things are going well; if they have risen things are not going well. If stones are still forming, supersaturations need to be lower. If there have been no more stones and supersaturations are stable, stand pat. If supersaturations are below 1 and stones are still forming, the urine samples do not properly represent your real life.
A Good Schedule
When? I like two 24 hour urines before treatment – it gives a sense of averages. After treatment has begun – diet changes, fluid goals, lifestyle, it is important to get another. The timing is up to patients: You know when something has changed, or ought to have changed, and need to be sure it has indeed changed in the right direction. It goes on like that until treatment is reaching its goals – lowering supersaturation by at least half – after which once a year is a good idea.
Hi Dr. Coe,
I wanted to see if I could get your thoughts on my recent blood work and 24-hour urine study. Thanks in advance.
BASIC METABOLIC PANEL
GLUCOSE = 86, Reference Range: 65-99 mg/dL
UREA NITROGEN (BUN) = 15, Reference Range: 7-25 mg/dL
CREATININE = 0.79, Reference Range: 0.70-1.30 mg/dL
EGFR = 102, Reference Range: > OR = 60 mL/min/1.73m2
BUN/CREATININE RATIO: Not Reported because BUN and Creatinine are within reference range.
SODIUM = 140, Reference Range: 135-146 mmol/L
POTASSIUM = 4.4, Reference Range: 3.5-5.3 mmol/L
CHLORIDE = 107, Reference Range: 98-110 mmol/L
CARBON DIOXIDE = 27, Reference Range: 20-32 mmol/L
CALCIUM = 9.2, Reference Range: 8.6-10.3 mg/dL
VITAMIN D 25-OH = 32, Reference Range: 30-100 ng/mL
PARATHYROID HORMONE INTACT = 46, Reference Range: 16-77 pg/mL
PHOSPHATE (AS PHOSPHORUS) = 2.9, Reference Range: 2.5-4.5 mg/dL
Urine Volume (Preserved) = 4010 High
Calcium Oxalate Saturation = 4.46 Low
Calcium, Urine = 406 High
Oxalate, Urine = 35
Citrate, Urine = 1004
Calcium Phosphate Saturation = 0.68
pH, 24 hr, Urine = 6.057
Uric Acid Saturation = 0.36
Uric Acid, Urine = 771
Sodium, Urine = 161 High
Potassium, Urine = 61
Magnesium, Urine = 113
Phosphorus, Urine = 1000
Ammonium, Urine = 53
Chloride, Urine = 177
Sulfate, Urine = 42
Urea Nitrogen, Urine = 12.46
Protein Catabolic Rate = 1.0
Creatinine, Urine = 1821
Creatinine/Kg Body Weight = 19.6
Calcium/Kg Body Weight = 4.4 High
Calcium/Creatinine Ratio = 223 High
Hi William, your urine calcium is high and could cause calcium stones whenever your urine volume is lower – the present high value may not be tolerable long term. I presume it is idiopathic hypercalciuria. Of note, the borderline serum phosphate would make me think of a possible phosphate transporter abnormality for which oral phosphate might be preferable to routine standard measures. This would entail gene testing for NaPi 2A,2C variants, now a fairly routine matter you physicians might with to consider. Regards, Fred Coe
Hello,
I am waiting to hear from my doctor, just got this report, and I’m not sure what it means, maybe you can help:
Oxalates, Urine 24hr
Current result 2 low
Units mg/24hr
Reference interval 4-31
Total Volume: 225 ml
Thank you
Hi Lynn, It is not a complete collection at 225 ml. As for oxalate, I doubt the lab because the lower limit seems too low (units seem mg/24 hour). This is not a proper 24 hour urine and I would not use it as shown. REgards, Fred Coe
Importance of Calcium to citrate, calcium to oxalate,Uric acid to creatinine, Oxalate to creatinine,Calcium to creatinine ratio in 24 hr urinalysis
Hi Prakash, Urine creatinine arises from muscle so those ratios express excretion rates (mass/day) per lean body mass indexed here by production of creatinine that arises only from muscle. Regards, Fred Coe
Hello,
I have medullary sponge kidney and have been suffering from recurring infections for years. The last stone that was analyzed was just a week ago, and it was 70% calcium phosphate.
The abnormalities from my last 24 hour urine collection are:
Calcium Oxalate Saturation- 4.05
Calcium, Urine- 226
Oxalate, Urine- 18
Citrate, Urine- 159
pH, 24 hr, Urine- 6.254
Sulfate, Urine- 17
Creatinine, Urine- 1207
Note the excessive variation in creatinine excretion,
suggesting a discrepancy in the collection process. The
urine creatinine result was verified by repeat analysis.
From what I’ve been reading, it looks like I may have RTA 1, but your opinion would be more accurate.
Thank you
Hi JoJasim, I suspect you do not have MSK but calcium phosphate stones arising from a disorder – not necessarily RTA – that raises urine pH and lowers urine citrate.I presume the phosphate was hydroxyapatite not brushite. The latter is a special problem. In either case your care is complicated above the usual, and I am sure your physicians will pay special attention as to how to prevent more stones. regards, Fred Coe
I should have included the stone interpretation in my initial post.
70% Calcium phosphate (brushite). 20% Calcium phosphate (apatite). 10% Calcium oxalate dihydrate
I’ve had countless MRI, ultrasound, and X-rays, which all indicate MSK. I agree with you that I might have some sort of underlying condition.
Thank you for your reply,
Jo
Hi Jo, Brushite stones are among the most complex of all I deal with.I would urge your physicians to exert all possible approaches to prevention as they can grow rapidly and reduc rapidly. Best, Fred Coe
I submitted a comment a week or so ago. I do not see it. How do I find out if Dr Coe had replied?
Linda w
Hi Linda, I answered questions up to this date. If I have missed yours please send it again. Fred
I am doing my first 24hr urine soon. My 2 episodes of stones (3yrs apart) requiring surgery both revealed calcium oxalate but understand a 24hr urine will advise what foods, vitamin/mineral levels I’m lacking or high in so how to eat and what to take/stop taking. Who can I find to interpret this in simple terms to me? RDs in my area will not see me unless I have some stage kidney disease or diabetes. I’m asymptomatic with stones so totally unaware until bam, I’m septic! I’d love to stop or decrease this cycle at 68yrs old…I nearly died this past May! Thank you!
Hi Ruth, Oh my! The article you posted on could help. The report itself offers guidance. Is your personal physician unable to pitch in? Perhaps there is a medical school stone program within reach of where you live. People like me to telehealth but if you are in another state than Illinois or Indiana your physicians need to request a consultation. Best. Fred Coe
Hi there! I’m a 46 year old woman and these are my results from a 24 hour urine collection I did last week. Can you help me understand what I am looking at as I’ve been told things look just fine besides my Calcium being a little low. I just like to know things in detail. A thorough explanation of what all of this means.Thank you.
*Sodium, 24 HR, U 132mmol
*Potassium, 24 HR, U 30mmol
*Calcium, 24 HR, U Value 69mg
*Magnesium, 24 HR, U 41mg
*Chloride, 24 HR, U 120mmol
*Phosphorus, 24 HR, U 745mg
*Sulfate, 24 HR, U 15mmol
*Citrate Excretion, 24 HR, U 582mg
*Oxalate, 24 HR, U 0.28mmol
*Oxalate, 24 HR, U 24.6mg
*pH, 24 HR, U 5.6
*Uric Acid, 24 HR, U 538mg
*Creatine, 24 HR, U 1393mg
*Osmolality, 24 HR, U 461 mOsm/kg
*Ammonium, 24 HR, U 33mmol
*Urea Nitrogen, 24 HR 7.5g
*Protein Catabolic Rate 24 HR, U 72g
*Calcium Oxalate Crystal Value 0.97DG
*Brushite Crystal Value -2.15DG
*Hydroxyapatite Crystal Value 0.81DG
*Uric Acid Crystal Value 2.88DG
*Volume 1379ml
Thank you.
Curious
Hi LaShara, I see low calcium and magnesium, ammonia much higher than sulfate meaning that there is a source of acid in excess of the usual sulfate from diet protein – or a loss of alkali from the GI tract, low urine pH (meaning the kidneys are responding as if to an acid load but urine citrate is normal. I see this kind of picture with metabolic syndrome, obesity. But the low magnesium speaks for GI or renal losses – laxatives, diuretics, possible alcohol excess. Risk is for uric acid stones. Lacking any clinical information this is just looking at numbers, so I cannot offer a real medical opinion of even the most provisional kind. Best, Fred Coe
Hello, Dr. Coe. Any insight on the abnormalities of my recent test results would be most appreciated. Thank you.
Calcium oxalate sat. 2.45
Oxalate urine 19
Citrate urine 395
Calcium phosphate sat. 0.29
ph 24 hr urine 6.209
sodium urine 43
phosphorus urine 403
chloride urine 40
Also, last week from blood and urine testing:
Complement C4C 14 low
Creatinine serum 1.06 high
lambda light chain free serum 102.0 high
kappa/lambda light chain free ration serum 0.17 low
IFE urine free monoclonal lambda light chain band detected
Also, my ANA titer is 1.320 speckled
EGFR dropped to 59 last month, now back to 63
Potassium was 6.2 last month, now back down (because I eliminated it largely from diet)
Thank you for any insight.
Lambda
urea nitrogen urine 5.33
Hi Andria, Your situation is beyond the scope of this site. It would appear you have a complex disorder with a related kidney disease, and I did not prepare this site to accommodate such conditions. I am sure you have a nephrologist as well as an expert in immune diseases already who are dealing with what you have shown. Best, Fred Coe
Hi Dr. Coe,
I wanted to see if I could get your thoughts on my recent blood work and 24-hour urine study. I have been suffering from multiple stones per year (6-10) from 2.5 mm to 8.5 mm. All since my early 30s and I am 48 now. Everyone on my mothers side also had the same problems. anything you can provide would be very appriciated.
Accession ID: 227L4845150 Lab Ref ID: 27928049
Order Date: 08/11/2024
Collection Date: 08/11/2024 15:15:00
Litholink 24Hr Urine Panel
NAME VALUE REFERENCE RANGE LAB
F Cystine, Urine, Qualitative Neg Negative 01
F Urine Volume (Preserved) 1320 500-4000 (mL/24 hr) 01
F Calcium Oxalate Saturation 10.62 H 6.00-10.00 01
F Calcium, Urine 239 450 (mg/24 hr) 01
F Calcium Phosphate Saturation 2.20 H 0.50-2.00 01
F pH, 24 hr, Urine 5.997 5.800-6.200 01
F Uric Acid Saturation 1.39 H <1.00 01
F Uric Acid, Urine 934 H <800 (mg/24 hr) 01
F Sodium, Urine 223 H 50-150 (mmol/24 hr) 01
F Potassium, Urine 81 20-100 (mmol/24 hr) 01
F Magnesium, Urine 74 30-120 (mg/24 hr) 01
F Phosphorus, Urine 1400 H 600-1200 (mg/24 hr) 01
F Ammonium, Urine 36 15-60 (mmol/24 hr) 01
F Chloride, Urine 197 70-250 (mmol/24 hr) 01
F Sulfate, Urine 46 20-80 (meq/24 hr) 01
F Urea Nitrogen, Urine 11.79 6.00-14.00 (g/24 hr) 01
F Protein Catabolic Rate 0.9 0.8-1.4 (g/kg/24 hr) 01
F Creatinine, Urine 2235 Not Applic. (mg/24 hr) 01
F Creatinine/Kg Body Weight 23.0 11.9-24.4 (mg/24 hr/kg) 01
F Calcium/Kg Body Weight 2.5 <4.0 (mg/24 hr/kg) 01
F Calcium/Creatinine Ratio 107 34-196 (mg/g creat) 01
F Comment Note 01
F PDF . 01
PERFORMING LAB: Labcorp Itasca, 150 Spring Lake Drive, Itasca, Phone – 6306947400, Director – PhDGruzdys
Hi Jamie, You have a high SS CaOx but did not show the urine oxalate excretion. Was it high? I suspect it may be. Regards, Fred Coe
Hi
I am 54, female, 5’9” 224 lbs
I had a terrible issue with kidney stone blocking my urethra line last month so they had me do a Litholink. My stone was 5 mm, calcium oxidate and calcium oxidate dehydrate
I have pretty normal blood levels.
On the Litholink results that were abnormal were:
Protein Catabolic Rate was 0.58
Calcium Oxalate Saturation 5.72
This confuses me. I thought Calcium Oxalate would be high
Any thoughts?
Hi Sarah, The information you provide is inadequate for me to be helpful. If you would like to post all of the numbers I could try. Regards, Fred Coe
Hello. I’m struggling with kidney stones for 5 years now and don’t understand the 24 hour urine results.
I hope you can shed some light. Lithotripsy scheduled for this Monday for 2 more larger stones.
62 yo Caucasian female
-High 2.14 Calcium phosphate saturation
-High 6.854 PH/ 24 hour urine
-High 145 Sodium/ urine
-Low 4.29 Calcium Oxylate saturation
I appreciate anything you can share for dietary changes or other advice. Thank you in advance.
Hi Lesley, from the fragmentary lab data your urine is alkaline and saturated with respect to calcium phosphate pointing to calcium phosphate stones. The causes are buried in the rest of the urine data and your blood chemistries, I am afraid. Regards, Fred Coe
Hi Dr. Coe!
I have been in and out of the hospital this month for a kidney stone – I’m a 34 F at 107lbs and I received a urinalysis test but none of my doctors have discussed the results with me. I have never had issues with kidney stones before but they found that I have a cluster on my left side in addition to the 8mm stone on my right side. Sound wave treatment didn’t work on this stone so I am going in again for a laser treatment. Hoping to find out what is causing these so I can get on top of preventative care. Any insight would be appreciated! Thank you so much! Results are as follows:
CALCIUM OXALATE CRYSTAL
Normal value: Reference Mean= 1.59 DG
Value: 0.82
BRUSHITE CRYSTAL
Value: 0.00
HYDROXYAPATITE CRYSTAL
Normal value: Reference Mean= 3.62 DG
Value: 5.12
URIC ACID CRYSTAL
Normal value: Reference Mean= 0.89 DG
Value: -5.19
SODIUM, 24 HR, U
Normal range: 22 – 328 mmol/24 h
Value: 99
POTASSIUM, 24 HR, U
Normal range: 16 – 105 mmol/24 h
Value: 42
CALCIUM, 24 HR, U
Normal value: <200 mg/24 h
Value: 120
MAGNESIUM, 24 HR, U
Normal range: 51 – 269 mg/24 h
Value: 90
CHLORIDE, 24 HR, U
Normal range: 34 – 286 mmol/24 h
Value: 78
PHOSPHORUS, 24 HR, U
Normal range: 226 – 1797 mg/24 h
Value: 810
SULFATE, 24 HR, U
Normal range: 7 – 47 mmol/24 h
Value: 2
CITRATE EXCRETION, 24 HR, U
Normal range: 250 – 1191 mg/24 h
Value: 393
OXALATE, 24 HR, U (MMOL/24 HR)
Normal range: 0.11 – 0.46 mmol/24 h
Value: 0.27
OXALATE, 24 HR, U (MG/24 HR)
Normal range: 9.7 – 40.5 mg/24 h
Value: 23.8
PH, 24 HR, U
Normal range: 4.5 – 8.0
Value: 6.6
URIC ACID, 24 HR, U
Normal range: 250 – 750 mg/24 h
Value: 330
CREATININE, 24 HR, U
Normal range: 603 – 1783 mg/24 h
Value: 990
OSMOLALITY, 24 HR, U
Normal range: 150 – 1150 mOsm/kg
Value: 168
AMMONIUM, 24 HR, U
Normal range: 15 – 56 mmol/24 h
Value: 25
UREA NITROGEN, 24 HR, U
Normal range: 7.0 – 42.0 g/24 h
Value: 4.8
PROTEIN CATABOLIC RATE, 24 HR, U
Normal range: 56 – 125 g/24 h
Value: 55
Hi Kiera, your results are a bit odd. Citrate is low and pH high as in calcium phosphate stone formers. Your urine sulfate is too low – I suspect it is 22 not 2. Your urea nitrogen is low as well as if your protein intake were below adequate. Your protein catabolic rate is copied wrong and must be 0.55. ALtogether your diet is suspect but there is a low citrate and high pH which could contribute to your stones. Knowing nothing about your situation I leave interpretation to your physicians. They must account for what is wrong. Best, Fred Coe
Could you please help me interpret my 24 test?
Volume=2740
Calcium oxalate saturation =4.98
Calcium, urine = 458
Citrate, urine = 768
Calcium phosphate saturation = 1.11
Uric acid saturation = 5.783
Uric acid, urine 1027
Sodium, urine = 147
Potassium, urine = 89
Magnesium, urine = 143
Phosphorus, urine = 1469
Ammonium, urine = 49
Chloride, urine =155
Sulfate , urine = 45
Phosphorus, urine = 1469
Ammonium, urine = 49
Chloride, urine = 155
Sulfate, urine = 45
Urea nitrogen, urine = 15.3
Protein, catabolic rate = 1.5
Creatinine, urine = 1602
Creatinine/kg body weight = 22.8
Calcium/kg body weight 6.5
Calcium/ creatinine ratio = 286
Hi Julie, Very high urine calcium and protein intake – the latter can raise the former. Acid urine. High phosphate. Probably hereditary hypercalciuria + massive diet protein loading. Also possible – the urine was over-collected (more than 24 hours) This is pure guess work, and meant only as a prompt. Your physicians are in charge and need to interpret for you. Regards, Fred Coe
Hi Dr Coe,
Any insight on these 24hr Urine results?
I was diagnosed with Medullary Nephrocalcinosis after finding out I had a kidney stone earlier this summer. I had lithrotripsy, but now trying to figure out the cause of the stones.
Thank you!
Calcium Oxalate Saturation – LOW
3.46
Calcium, Urine HIGH
301
Calcium Phosphate Saturation HIGH
2.75
pH, 24 hr, Urine HIGH
7.063
Sodium, Urine HIGH
156
Magnesium, Urine HIGH
144
Calcium/Kg Body Weight HIGH
4.4
Hi Samantha, YOur urine calcium is high and pH very high pointing toward calcium phosphate stones. You may have underlying renal tubular acidosis. Your physicians need to figure out the problem and treat you to prevent more crystallization. Regards, Fred Coe
Good morning. Received my results and do not understand them as well
Litholink 24Hr Urine Panel
Cystine, Urine, neg
warningHighCalcium Oxalate Saturation
16.72
warningHighCalcium, Urine
295
warningHighOxalate, Urine
49
Citrate, Urine
727
Calcium Phosphate Saturation
1.81
warningLowpH, 24 hr, Urine
5.743
warningHighUric Acid Saturation
2.4
warningHighUric Acid, Urine
892
warningHighSodium, Urine
193
Potassium, Urine
52
warningHighMagnesium, Urine
121
Phosphorus, Urine
1101
Ammonium, Urine
38
Chloride, Urine
198
Sulfate, Urine
44
Urea Nitrogen, Urine
10.62
Protein Catabolic Rate
1.0
Creatinine, Urine
1449
Reference Interval: Not Applic., Unit: mg/24 hr
Creatinine/Kg Body Weight
17.7
Calcium/Kg Body Weight
3.6
Calcium/Creatinine Ratio
204
Hi Amee, your urine calcium is high and if you form calcium stones it would be a main cause. Your urine is rather acid so you could form uric acid stones as well. Regards, Fred Coe
Hello! I cannot find my comment so I am going to resubmit just in case it did not go through. I am a 20yo female with a history of repeated stone formation since early 2021 at 16yo. I have been hospitalized eight different times for passing a stone, each time on my left except for the most recent one a month ago. I have many stones in my right kidney that are just sitting there and have been for over a year by now. I had a shockwave lithotripsy procedure done June of 2023 on my left side on a 13mm stone. I have had many recurrent UTIs which are always asymptomatic until they progress into kidney infections. I have had two confirmed kidney infections with a third kidney infection suspected about a year ago. I just got a 24hr urine test done and would love some insight into the results.
Total Urine Volume: 0.94 L
PH Urine: 6.0
Calcium: 172
Oxalate: 19
Uric Acid: 365
Citric Acid: 275 L
Sodium: 67
Sulfate: 6
Phosphorous: 705
Magnesium: 96
Potassium: 20
Creatinine: 900
Calcium Oxalate: 2.55 H
Brushite: 3.23 H
Sodium Urate: 1.98
Uric Acid: 1.62
I was told I have low urine volume, hypocitraturia / hypocitraturic nephrolithiasis, and supersaturation index with respect to calcium oxalate and brushite. What should I do moving forward? Do you think there is an underlying disorder causing the hypocitraturia or that it is idiopathic? I would love your insight.
Thank you so much.
Hi Jordan, Your urine citrate is very low for a young woman and one clue is your low urine potassium – potassium depletion lowers citrate. Low potassium can arise from GI issues like vomiting, or diarrhea, or use of laxatives or diuretics – perhaps one of these applies here. Your urine sulfate is very low – that points to low protein intake and perhaps diet issues. Of course the volume is terribly low and will promote stones. Your physicians probably know the real reasons for all this, but I cannot – being merely a reader of numbers. I think things need to be corrected. Regards, Fred Coe
Hello!
I recently had my calcium oxalate stone removed along with my stent placed. I then took my 24 hour urine test.
I have received my 24 hour urine test results back and I had an 1.86 calcium oxalate saturation which was consider low. everything else on my test was in the normal ranges as well from my 24 hour urine test. I have decreased and cut out all of the things I thought might have caused my kidney stone in the first place so hoping that a low number means my risk of developing another one is low?
Hi Ryan, I presume your diet, fluids, etc changed from when you formed stones to when you measured. The present values shown or suggested seem unlikely to cause stones. But you need to keep things this way. Regards, Fred Coe (I deleted the other 3 versions of this same question). Fred
Hello Dr. Coe,
I have been suffering from chronic kidney stones, infections and severe sepsis episodes due to blockages and infections for roughly 15 years. I have undergone over a dozen procedures both Lithotripsy & Ureteroscopy, with stent placements. Simultaneously have Idiopathic IBS, which can cause dehydration. I recently switched urologists as my previous doctor did not seem intent on finding an issue or treating any issues, just dealing with the problems as they arose. Unfortunately that found me hospitalized numerous times. My new doctor mentioned that my calcium levels have been high previously, and subsequently could be hypercalcemia/hyperparathyroidism.
My stones vary between Calcium Oxalate, Hydroxyapatite, Calcium Oxalate Monohydrate, CaHPO4 (Brushite), Calcium phosphate, Ca oxalate dihydrate, so all over the board. I do practice a low oxalate diet, and drink over a gallon of water a day.
Below are my results from my most recent 24h urine test. Can you give me your insight?
Urine Volume (Preserved) 01 1760 mL/24 hr
Calcium Oxalate Saturation01 10.69 High
Calcium, Urine01 264 High (The urine Ca result was verified by repeat analysis.)
Oxalate, Urine01 41 High
Citrate, Urine01 480 Low
Calcium Phosphate Saturation01 2.35 High
pH, 24 hr, Urine01 6.449
Uric Acid Saturation01 0.35
Uric Acid, Urine01 765
Sodium, Urine 01 130
Potassium, Urine 01 28
Magnesium, Urine 01 63
Phosphorus, Urine 01 844
Ammonium, Urine 01 53
Chloride, Urine 01 121
Sulfate, Urine 01 39
Urea Nitrogen, Urine 01 11.02
Protein Catabolic Rate 01 1.2
Creatinine, Urine 01 1168
Creatinine/Kg Body Weight 01 17.4
Calcium/Kg Body Weight 01 3.9
Calcium/Creatinine Ratio 01 226
Hi Dana, I think you have converted from calcium oxalate stones to mixtures of calcium phosphate stones (HA, brushite calcium phosphate). Your urine is overly alkaline (pH 6.44) calcium high, and tellingly urine ammonia (a say to remove acid) higher than your diet acid load (urine sulfate). The brushite is most worrying. As for primary hyperparathyroidism you do not offer serum data. From here there is no way I can help you but given sepsis and brushite perhaps your physicians might want to consider referral to a university stone center geographically near you. Your problems seem beyond what physicians will in general have encountered. Regards, Fred Coe
Hi Dr. Coe, What do you think of the results of my Litholink? I’m being considered as a kidney donor and they found a 3mm stone in my left kidney so they ran this and it seems to have so many areas not in “normal” range which worries me. All my other tests came back stellar. I’m going to speak to the team head this week, but I’d love an independent opinion on this. Thank you.
Cystine, Urine, Qualitative
Normal value: Negative
Value
Neg
Urine Volume (Preservative)
Normal range: 500 – 4,000 mL/24 hr
Value: 3740
Calcium Oxalate Saturation
Normal range: 6.00 – 10.00
Value: 2.99
CALCIUM 24 HOUR, URINE
Normal value: 550 mg/24 hr
Value
465
Calcium Phosphate Saturation
Normal range: 0.50 – 2.00
Value: .71
PH, 24 HR URINE
Normal range: 5.800 – 6.200
Value: 6.719
Uric Acid Saturation
Normal value: <1.00
Value
0.11
URIC ACID, URINE, 24 HOUR
Normal value: <750 mg/24 hr
Value
851
SODIUM ,URINE, 24 HOUR
Normal range: 50 – 150 mmol/24 hr
Value: 178
POTASSIUM URINE 24 HOUR
Normal range: 20 – 100 mmol/24 hr
Value: 100
MAGNESIUM, 24HR URINE
Normal range: 30 – 120 mg/24 hr
Value: 141
PHOSPHORUS, URINE 24 HOUR
Normal range: 600 – 1,200 mg/24 hr
Value: 920
AMMONIUM URINE
Normal range: 15 – 60 mmol/24 hr
Value: 30
CHLORIDE, URINE, 24 HOUR
Normal range: 70 – 250 mmol/24 hr
Value: 173
SULFATE 24 HOUR URINE
Normal range: 20 – 80 meq/24 hr
Value: 62
UREA NITROGEN, URINE 24 HOUR
Normal range: 6.00 – 14.00 g/24 hr
Value 15.30
PROTEIN CATABOLIC RATE,U
Normal range: 0.8 – 1.4 g/kg/24 hr
Value: 1.5
CREATININE, URINE
Normal value: Not Applic. mg/24 hr
Value
1,282
Creatinine/Kg Body Weight
Normal range: 8.7 – 20.3 mg/24 hr/kg
Value: 17.9
Calcium/Kg Body Weight
Normal value: <4.0 mg/24 hr/kg
Value
2.5
CALCIUM/CREATININE RATIO
Normal range: 51 – 262 mg/g creat
Value: 138
Hi Sharon, Your urine calcium is very high indeed. You have presented the wrong value for urine calcium / creatinine as the right value is 465 mg/d calcium/1282 mg/d creatinine or 362 mg calcium /gm creatinine. But perhaps the ratio is correct and you have misquoted the urine calcium. Since the results do not tally correctly I hesitate to say much about so important and vexed an issue of donorship. If indeed your urine calcium is 465 mg/day and you have a stone some experts might demur. But if perhaps you have quoted the wrong urine calcium (using the ratio of 138 mg/gm creatine gives 138×1.282 or 176.9 mg calcium/day) then donorship would seem less concerning. Regards, Fred Coe
I’m sorry – clearly I made a mistake somewhere in copying and pasting. The 465 value is Citrate, Urine. I’m trying again. I’m not able to see it when I send it, so I hope it’s correct this time. I’m looking at it in the window here and it is.
Cystine, Urine, Qualitative
Normal value: Negative
Value
Neg
Urine Volume (Preservative)
Normal range: 500 – 4,000 mL/24 hr
Value: 3740
Calcium Oxalate Saturation
Normal range: 6.00 – 10.00
Value: 2.99
CALCIUM 24 HOUR, URINE
Normal value: 550 mg/24 hr
Value
465
Calcium Phosphate Saturation
Normal range: 0.50 – 2.00
Value: .71
PH, 24 HR URINE
Normal range: 5.800 – 6.200
Value: 6.719
Uric Acid Saturation
Normal value: <1.00
Value
0.11
URIC ACID, URINE, 24 HOUR
Normal value: <750 mg/24 hr
Value
851
SODIUM ,URINE, 24 HOUR
Normal range: 50 – 150 mmol/24 hr
Value: 178
POTASSIUM URINE 24 HOUR
Normal range: 20 – 100 mmol/24 hr
Value: 100
MAGNESIUM, 24HR URINE
Normal range: 30 – 120 mg/24 hr
Value: 141
PHOSPHORUS, URINE 24 HOUR
Normal range: 600 – 1,200 mg/24 hr
Value: 920
AMMONIUM URINE
Normal range: 15 – 60 mmol/24 hr
Value: 30
CHLORIDE, URINE, 24 HOUR
Normal range: 70 – 250 mmol/24 hr
Value: 173
SULFATE 24 HOUR URINE
Normal range: 20 – 80 meq/24 hr
Value: 62
UREA NITROGEN, URINE 24 HOUR
Normal range: 6.00 – 14.00 g/24 hr
Value 15.30
PROTEIN CATABOLIC RATE,U
Normal range: 0.8 – 1.4 g/kg/24 hr
Value: 1.5
CREATININE, URINE
Normal value: Not Applic. mg/24 hr
Value
1,282
Creatinine/Kg Body Weight
Normal range: 8.7 – 20.3 mg/24 hr/kg
Value: 17.9
Calcium/Kg Body Weight
Normal value: <4.0 mg/24 hr/kg
Value
2.5
CALCIUM/CREATININE RATIO
Normal range: 51 – 262 mg/g creat
Value: 138
Hi Sharon, If your citrate (shown as calcium) is 465 it is low, and your urine pH is high. This pattern is common to phosphate stone formers. Presently your SS for CaP is below 1 so whatever is going on with you this urine – at least – shows no serious stone risk. You alone know if it represents your usual life – or not. Regards, Fred Coe
I don’t want to waste your time. Something is happening when it posts and the numbers are off so please don’t bother wasting your time here. My calcium is NOT 465. 176.
Hi Sharon, No problem. See my recent answer. Fred
Can you help me interpret my 24 hour urine panel? (I have been taking magnesium and topomax for migraines for about 25 years)
Cystine, Urine, Qualitative:
result – negative
reference int: negative
Urine volume
result: 3980 (ml/24hr)
j
calcium oxalate saturation
result: 4.22
calcium, urine
result 390
oxalate, urine
result 41
citrate, urine
result 396
calcium phosphate saturation
result 1.75
ph, 24 hr, urine
result 7.028
uric acid saturation
result .03
uric acid, urine
result 561
sodium, urine
result 196
potassium, urine
result 72
magnesium, urine
result 206
phosphorous, urine
result 875
ammonium, urine
result 31
chloride, urine
result 196
sulfate, urine
result 42
urea nitrogen
result
12.87
protein catabolic rate
result 1.5
creatine, urine
1330
creatine/kg body weight
result 21.4
calcium/kg body weight
result 6.3
calcium/creatine ratio
result 294
Hi Renee, Oh my! The Topamax is causing high urine pH low citrate and high calcium and great risk for calcium phosphate stones. Your physicians must find another medication for you as the stones can pose real health hazards. Best, Fred Coe
I was diagnosed with Medullary sponge kidneys in the 80s. I’m 66 yrs old female. 5’ 4 116lbs. I’ve passed over 50 stones and have had lithotripsy 1x in the 80s and 4 stone removal surgeries due multiply stones stuck. Last surgery 9 years ago. I’ve used homeopathic remedies to help with pain when passing a stone. I’ve passed some large stones. I’ve been vegan and now Whole Foods plant based for 19 years. I had a recent 24hr urine collection and wonder your thoughts as to the results.
CALCIUM 196
OXALATE 41
URATE 791High
CITRATE. 785
PH. 7.0
SPECIMEN VOLUME. 2.42
SODIUM. 83
SULFATE. 17
PHOSPHATE 644
.
MAGNESIUM. 126
AMMONIA 31
POTASSIUM 62
CREATININE. 837
CALCIUM OXALATE index 1.46
CALCIUM HYDROG. PHOSPH. DIHYDRATE. 1.98
URATE 1.04
TRIPLe Phosphate 6.11
SODIUM URATE. 0.17
Hi Myra, The most striking feature is the high pH. Do you form calcium phosphate stones? Your urine ammonia exceeds your urine sulfate, a trait I see in calcium phosphate stone formers. Do you know what your stones are made of? Regards, Fred Coe
I also forgot to say I’ve been vegan for 18 years and try to follow a Whole Foods plant based diet.
My records show my stones have been calcium oxalate.
Hi Myra, Just kepp analysing stones you pass or have removed and if phosphate percentages rise be sure your physicians respond appropriately. Best, Fred Coe
Hi Dr. Coe,
I am a 38 yr old stone former. My first symptom was renal colic 12 years ago. I experienced the same 5 years ago as well, then again a few months ago. I’ve never passed a stone, and have had mixed readings in various CT/ultrasound as to their presence. Recently my ultrasound showed 3 6-7mm stones in the right kidney and a 7mm in the left. I’ve finally had a 24hr urinalysis and wondered your thoughts. Is Thiazide a must for patients with these readings or are dietary changes potentially enough? (I already drink a lot of water, though wasn’t before this last stone).
Urine Volume (Preserved) 01- 4030
Calcium Oxalate Saturation 01- 3.3
Calcium, Urine 01- 352
Oxalate, Urine 01- 32
Citrate, Urine 01- 476
Calcium Phosphate Saturation 01- 1.38
pH, 24 hr, Urine 01- 6.486
Uric Acid Saturation 01- .15
Uric Acid, Urine 01- 785
Sodium, Urine 01- 130
Potassium, Urine 01- 82
Magnesium, Urine 01-133
Phosphorus, Urine 01- 1309
Ammonium, Urine 01- 62
Chloride, Urine 01- 147
Sulfate, Urine 01- 56
Urea Nitrogen, Urine 01- 13.25
Protein Catabolic Rate 01- 1.4
Creatinine, Urine 01- 1911
Creatinine/Kg Body Weight 01- 28.1
Calcium/Kg Body Weight 01-5.2
Calcium/Creatinine Ratio 01- 184
Hi Greg, YOur urine calcium is high despite a very reasonable urine sodium level of 130 mEq/d. Partly it is your high protein intake of 1.4 gm/kgd which could be safely brought to 1. If you do that perhaps your stone risk can be brought into a reasonable range. Regards, Fred Coe
Hi Dr. Coe. I was hoping you could give me some insight on my test results. I’ve been having to self advocate for myself for over 3 yrs now in hopes to reach a dx and has been a very slow difficult process for me. I believe I’ve been going misdiagnosed for a number of years now and my health seems to be declining all the while. I have a hx of heart failure with a near fatal low potassium level at the age of 33 and was given a dx of venous insuffiency and put on diuretics. A few years prior to this I suffered numerous thoracic vertebral fx’s and a humerus fx. And when going through my medical records a short time ago I found a few months prior to my hospitalization and was seem at the ER was something not related to but an EKG and labs were taken that evening and the results of these were never disclosed to me. I has a blood serum calcium level of 0.0 that was never flagged and written at the top of the original EKG print out read Acute injury/illness but was then deemed normal due to no other EKGs to use as comparison. In the year 2017 I developed hypertension and was put on medication for this also. About 5 months ago I stopped all meds due to the fact I started to develop these lupus like sores when exposed to sunlight after taking my diuretic and my pcp at that time didn’t feel that was the cause of it. I’ve been dx with low, high, and orthostatic blood pressure in the past 10 years and now is running very low at times without medication. Also at age 21 I was dx with hypoglycemia and now finding my blood sugars to be high and my last A1c is at pre-diabetes level. Any information you have to offer would be greatly appreciated. Thank you for your time. Comments & Additional Information
Clinical Info: Collection 1
Total Volume: 1680 ml
Date Collected: 05/27/2024
Litholink 24Hr Urine Panel
Test
Current Result and Flag
Previous Result and Date
Units
Cystine, Urine, Qualitative
Neg
Reference Interval
Negative
Urine Volume (Preserved)
1680
mL/24 hr
500-4000
Calcium Oxalate Saturation
7.69
6.00-10.00
▲ Calcium, Urine”
318
High
mg/24 hr
550
Calcium Phosphate
Saturation”
1.64
0.50-2.00
A pH, 24 hr, Urine
6.537
High
5.800-6.200
Uric Acid Saturation”
0.17
<1.00
Uric Acid, Urine
449
mg/24 hr
<750
▲ Sodium, Urine 01
332
High
mmol/24 hr
50-150
Potassium, Urine 01
39
mmol/24 hr
20-100
Urine
▼Phosphorus, Urine
Ammonium, Urine
157
High
mg/24 hr
30-120
465
Low
mg/24 hr
600-1200
40
mmol/24 hr
15-60
▲ Chloride, Urine
363
High
mmol/24 hr
70-250
Sulfate, Urine o
15
Low
meq/24 hr
20-80
▼
Urea Nitrogen, Urine"
5.59
Low
g/24 hr
6.00-14.00
Protein Catabolic Rate
0.8
g/kg/24 hr
0.8-1.4
Creatinine, Urine
1206
mg/24 hr
Not Applic.
▲ Creatinine/Kg Body Weight"
21.3
High
mg/24 hr/kg
8.7-20.3
▲ Calcium/Kg Body Weight
5.6
High
mg/24 hr/kg
<4.0
▲ Calcium/Creatinine Ratio"
264
High
mg/g creat
51-262
Comment
Note
PDF
Disclaimer
The Previous Result is listed for the most recent test performed by Labcorp in the past 5 years where there is sufficient patient demographic data to the result to the patient. Results from certain tests are excluded from the Previous Result display.
Icon Legend
▲ Out of Reference Range Critical or Alert
labcorp
2024 Laboratory Corporation of America Holdings All Rights Reserved – Enterprise Report Version 2.00
Hi Marcy, I see a very high urine calcium and massive high urine sodium, the latter is from your diet and the high calcium is in part from the high sodium. Very high diet sodium is not healthy and if you lowered it to the US upper limit of 100 mEq/d your calcium might come down. That is all I can surmise from the labs taken – so to speak – without real clinical context. Best, Fred Coe
I forgot to include that in 3/2022 it was found that I had a vit D 25 level of 15 and was given 50,000units of Vit D2 to take once a week for 16 weeks. This was the first time I have received any sort of TX for a obvious known condition that I’ve had for a long time..low vit D. But at that time I suspected I was losing calcium through my urine in high amounts but was unable to find a doctor to give a 24 hour Urine collection test and it took 2 more years to obtain this. That same year around November was when I passed my first kidney stone and I believe in my opinion was a Oxulate stone. A week later I felt as though another one was trying to pass but never felt one pass and seemed like maybe it was in my bladder and was left like this for another 6 months. And at the beginning of the 2024 year my Efgr was 117 and my last one in 5/2024 was 75.
Hi Marcy, Now that your serum vitamin D levels are normal- I presume – I would repeat a new 24 hour urine stone panel with a renal panel to see what things look like in terms of stone risk. Regards, Fred Coe
And I’m now 44 and having and experiencing short term memory loss and narcolepsy like episodes when exposed to stress and/or physical exertion. Also at the time of my hospitalization ten years ago there were a couple other labs that was out of range and I can’t recall if treatment was done at that time but I do know other tests were given to find the cause of these. I had a pH level of 8.5, calcium again of 0.0, and a anion gap of 14.
Hi Marcy, I cannot help much with what you remember. The anion gap is normal. Best. Fred
HI Dr. Coe:
I was wondering if you have has the chance for to review my results yet? I’m pretty sure I know from doing my own research of what is wrong with me and what I’m up against. I just need some insight on to prevent further damage to my kidneys and/or more stone reoccurance and maintain some sort of good bone heath until I can be properly dx and treatment started. Any calcium I eat or in supplements is almost instantaneously being flushed out again and it’s a matter of days when I feel a stone wanting to pass and basically eliminated all calcium from my diet because I don’t know what else to do at this point. Thank you for time and consideration.
Hi Mardy, Have I lost your question? I am at the end of my list (bottom of it meaning earlier ones). I shall look through as I answer forward. If you do not find anything please post again. Fred
Hello, I just had a 24 hour urine screen for kidney stones and was hoping you can help interpret my results. I am a female for reference.
I am worried the elevated calcium levels can be a sign of kidney damage. Thank you again!
CALCIUM OXALATE SATURATION: 4.88.
CALCIUM, URINE: 237 mg.
OXALATE URINE: 31 mg.
CITRATE URINE: 419.
PH URINE: 6.293.
PROTEIN CATABOLIC RATE: 1.6 g/kg/24 hr.
CREATININE URINE: 1182 mg.
CREATININE/KG BODY WEIGHT: 22.3 mg
CALCIUM/KG BODY WEIGHT: 4.5 mg.
CALCIUM/CREATININE RATIO: 200 mg/g.
Hi Agnes, Your urine calcium is high and citrate low, both stone risk factors. Not a sign of kidney disease. REgards, Fred Coe
Hi Dr,
Could you help interpret my results? I am 40yrs old and have been misdiagnosed with UTI since last year until a trip to the ER in May for on going pain discovered stones. Failed lithotripsy procedure and now waiting for a CT since stones moved. I drink a lot of water daily and have incontinence and wonder if it’s related to my stones. Also very large bladder possibly not emptying fully. Any insight is helpful. Thanks!
Hi Jackie, Urinary symptoms are common with stone passage. I am sorry you have them. When they are gone, and you feel well, get a proper evaluation for cause and guidance of prevention. Best, Fred Coe
Cystine, Urine, Qualitative °1 Neg
Urine Volume (Preserved) °1 2490
Calcium Oxalate Saturation °1 4.95 Low
Calcium, Urine °1 230 High
Oxalate, Urineº1 27
Citrate, Urine °1 747
Calcium Phosphate
Saturation °1 1.52
pH, 24 hr, Urine °1 6.583 High
Uric Acid Saturation °1 0.12
Uric Acid, Urine °1 453
Sodium, Urine °1 107
Potassium, Urine °1 57
Magnesium, Urine °1 54
Phosphorus, Urine® 767
Ammonium, Urine® 27
Chloride, Urine °1 101
Sulfate, Urine °1 28
Urea Nitrogen, Urine°1 8.20
Protein Catabolic Rate °1 0.9
Creatinine, Urine °1 1312
Creatinine/Kg Body Weight °1 19.4
Calcium/Kg Body Weight °1 3.4
Calcium/Creatinine Ratio °1 175
I made a mistake on the total volume of urineX it’s closer to 3- not sure if that would affect the results.
Hi Jackie, Your urine calcium is high, pH is high these are risk factors for calcium stones. Bests, Fred Coe
Hi Dr Coe,
I am confused by my recent 24 hour urine results. I have had multiple stones (usually seen in my kidneys but have passed at that point). The urologist I went to recently believes I had a UTI (sxs were the typical back pain but worse than normal and I also had decreased urine output and blood in my urine when I finally peed- no UTI sxs at that time) By the time I got my CT scan there were only stones in my other kidney.
Here are my results:
Cystine, Urine, Qualitative: Neg
Urine Volume (Preserved): 3430
Calcium Oxalate Saturation: 14.17 High
Calcium, Urine: 503 High
Oxalate, Urine: 123 High
Citrate, Urine: 410 Low
Ca Phos Saturation: 1.74
pH, 24 hr, Urine: 6.296 High
Uric Acid Saturation: 0.39
Uric Acid, Urine: 1221 High
Sodium, Urine: 394 High
Potassium, Urine: 94
Magnesium, Urine: 147 High
Phosphorus, Urine: 1654 High
Ammonium, Urine: 88 High
Chloride, Urine: 406 High
Sulfate, Urine: 77
Urea Nitrogen, Urine: 23.19 High
Protein Catabolic Rate: 2.2 High
Creatinine, Urine: 2030
Creatinine/Kg Body Weight: 28.9 High
Calcium/Kg Body Weight: 7.1 High
Calcium/Creatinine Ratio: 248
I also have Hereditary Fructose Intolerance so I’m not sure if that impacts any of my metabolic pathways.
Thank you!
Jackie
Hi Jackie, your urine calcium is very high and oxalate as well. I think the collection is more than 24 hours as the creatinine (from muscle) is so high per kg body weight you would have to be a professional muscle builder or else have overcollected. Even so I would get another because oxalate may be really high and calcium certainly is and these are major causes of stones. Best, Fred Coe
Dr. Coe,
Recently I had a bad UTI/kidney infection that didn’t respond to first 2 rounds of antibiotics. In the first week, I passed what appeared to be a large soft stone. It actually looked like a chunk of tofu but over the course of a few days it shrunk and turned tanish colored. I saved it and turned it in to be analyzed. The report only stated “ Crystalline substances normally associated with human
calculi were not identified. Infrared spectroscopy is
consistent with organic material.”. Could you please explain what that actually means? I appreciate your thoughts on this.
Thank you,
Lori
Hi Lori, It is probably protein. Often in stone formers some undetectably small amount of crystal will attract proteins around it to form so called ‘matrix’ stones. Nothing more than that except it often means stone risk is still too high. Regards, Fred Coe
Hi Dr. Coe,
I am a 55 year old female. I had my first stone last month. I strained for 6 weeks, but never got a stone. It was only after imaging that I found it was no longer there, so I assume it passed and somehow I missed a 4mm stone. My dr had me to the Litholink 24hr urine drop. Can you please help me figure out the results?
Urine volume 1.39lt
SS CaOx 21.85
Urine Calcium 250
Urine Oxalate 78
Urine Citrate 816
SS CaP 2.84
Ph 6.244
SS Uric Acid .58
Urine Uric Acid 648
Sodium 149
Potassium 54
Magnesium 104
Phosphorus 1119
Ammonium 20
Chloride 124
Sulfate 33
Urea Nitrogen 9.72
Protein Catabolic 1.0
Creatinine 1230
Calcium /Kg body weight 3.3
Calcium/Creatinine Ratio 204
Thank you for your awesome site. It has been very helpful for me.
Hi Cari, Your urine calcium is high and urine oxalate very high. Your physician needs to figure out why and get this treated. Regards, Fred Coe
Hello Dr Coe,
Thank you for providing this forum to learn more about kidney stone. I received the following results via the patient portal, and have not had a chance to review them with my provider yet. Wonder if you might be able to help decipher this in the meantime?
Test Result Normal Range
Cystine, Urine, Qualitative Negative Negative
Urine Volume (Preserved) 4060 500 – 4,000 mL/24 hr
Calcium Oxalate Saturation 296 6.00 – 10.00
Calcium, Urine 261 450 mg/24 hr
Calcium Phosphate Saturation 0.46 0.50 – 2.00
pH, 24 hr, Urine 6.339 5.800 – 6.200
Uric Acid Saturation 0.18 <1.00
Uric Acid, Urine 660 <800 mg/24 hr
Sodium, Urine 136 50 – 150 mmol/24 hr
Potassium, Urine 64 20 – 100 mmol/24 hr
MAGNESIUM 24H UR 144 30 – 120 mg/24 hr
Phosphorus, Urine 632 600 – 1,200 mg/24 hr
Ammonium, Urine 50 15 – 60 mmol/24 hr
Chloride, Urine 140 70 – 250 mmol/24 hr
Sulfate, Urine 54 20 – 80 meq/24 hr
Creatinine, Urine 1407 Not Applic. mg/24 hr
Creatinine/Kg Body Weight 16.7 11.9 – 24.4 mg/24 hr/kg
Calcium/Kg Body Weight 3.1 <4.0 mg/24 hr/kg
Calcium/Creatinine Ratio 196 34 – 196 mg/g creat
I have been passing stones quite frequently this past year, and even so more the past 2-3 months. I just received the analysis of one stone I caught.
Calcium Oxalate Monohydrate (Whewellite) 90%
Uric Acid 10%
Results should be interpreted with caution due to
poor library match.
Again, many thanks for your time & wisdom.
Michael
Hi Michael, YOur urine calcium is high and given the stone I suspect urine volume is not reliably high or urine oxalate is high – no value given. Regards, Fred Coe
Hi Dr,
Could you help interpret my results? I am 40yrs old and have been misdiagnosed with UTI since last year until a trip to the ER in May for on going pain discovered stones. Failed lithotripsy procedure and now waiting for a CT since stones moved. I drink a lot of water daily and have incontinence and wonder if it’s related to my stones. Also very large bladder possibly not emptying fully. Any insight is helpful. Thanks!
Cystine, Urine, Qualitative °1 Neg
Urine Volume (Preserved) °1 2490
Calcium Oxalate Saturation °1 4.95 Low
Calcium, Urine °1 230 High
Oxalate, Urineº1 27
Citrate, Urine °1 747
Calcium Phosphate
Saturation °1 1.52
pH, 24 hr, Urine °1 6.583 High
Uric Acid Saturation °1 0.12
Uric Acid, Urine °1 453
Sodium, Urine °1 107
Potassium, Urine °1 57
Magnesium, Urine °1 54
Phosphorus, Urine® 767
Ammonium, Urine® 27
Chloride, Urine °1 101
Sulfate, Urine °1 28
Urea Nitrogen, Urine°1 8.20
Protein Catabolic Rate °1 0.9
Creatinine, Urine °1 1312
Creatinine/Kg Body Weight °1 19.4
Calcium/Kg Body Weight °1 3.4
Calcium/Creatinine Ratio °1 175
Hi Jackie, I see high urine calcium and pH raising stone risk. Be sure the stone fragments are analysed because you may be forming calcium phosphate stones that have their own special problems. Regards, Fred Coe
I’m confused with my 24 hour collections.
Cal ox sat 11.06 & 12.02
Citrate urine 353
Ph 24hr urine 5.573
Uric a sat 1.03 & 2.14
Phos urine 592 & 459
Calcium urine 215
Uric a urine 820
I’m scheduled another 24hr collection in December but no idea what’s going on.
Teri Louviere
Hi Teri, I have no idea either. The SS for CaOx is very high, calcium is mildly increased, so either urine volume is very low, urine oxalate very high, or both. Take a look. Regards, Fred Coe