My Lab Report

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

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

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

Section One: Initial Evaluation

Answer the questions.

The blue responses are actions you should take

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

Select and print this list

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

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

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

Section Two: Follow up Evaluations

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

First answer the questions in Section One.

Then answer the questions here in Section Two

The blue responses are actions you should take

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

Select and print this list

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

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

65 Responses to “My Lab Report”

  1. kevin

    Hi Dr. Coe, my nephrologist suggested I visit your website and try reaching out to you as new onset to stones 2 years ago now, 1 year on meds and diet adjust and 24 hr urines still way off normal. diet mostly plant based protein, and un processed foods for last 4 years. fluid intake average 1 gallon a day 90% of which is plain water.

    here is last results :
    24 HOUR VOLUME 2.42 L/day
    PH 6.9
    CALCIUM 24 HOUR URINE 577 mg/day
    OXALIC ACID 24 HOUR URINE 40 mg/day
    URIC ACID 24 HOUR URINE 1,193 mg/day
    CITRIC ACID,24 HOUR URINE 2,141 mg/day
    SODIUM 24 HOUR URINE 387 mEq/day
    SULFATE 39 mmol/day
    PHOSPHORUS 24 HOUR 2,047 mg/day
    MAGNESIUM 24 HOUR URINE 232 mg/day
    AMMONIA 24HOUR URINE 44 mEq/day
    POTASSIUM 24 HOUR URINE 117 mEq/day
    CREATININE URINE 2,331 mg/day
    CALCIUM OXALATE 1.56
    BRUSHITE 7.20
    SODIUM URATE 6.14
    STRUVITE 14.17
    URIC ACID 0.30

    Reply
    • Fredric L Coe

      Hi Kevin, From the numbers, your urine calcium and oxalate are very high, citrate is very high, pH is high, and SS for calcium phosphate remarkable. I presume the urine is not over-collected and that the very high creatinine just reflects high muscle mass. Such massive sodium loading is surely raising your urine calcium, and I would start there – you are over 3 times above the US tolerable upper limit for diet sodium. The plant based diet is giving you lots of potassium and alkali so your urine pH is high which predisposes to calcium phosphate stones. My initial concern would be to get the diet sodium down drastically. It is so high that nothing can be done. If your nephrologist wants more detailed help for you from me, please let me know as that would amount to medical consultation. Regards, Fred Coe

      Reply
  2. Lorna

    As a newbie stone former at nearly 60 and a physician myself I have found your information amazingly helpful. Thankyou.

    Reply
  3. Alice

    Hi Dr. Coe, I have managed to lower my SS CaOx from 17.51 to 5.00, lower my SS UA from 0.49 to 0.02, my Ox 24 from 101 to 29. Calcium and citrate are normal. But my SS CaP rose from 1.61 to 2.47. Also my pH rose from 6.290 to 7.447. I was taking calcium with meals and magnesium citrate. Thank you. Ca 24 is 141 and Mg 24 is 299.

    Reply
    • Fredric Coe, MD

      Hi Alice, Perhaps the magnesium citrate is too much of a good thing – or perhaps the calcium is calcium citrate or calcium carbonate. Those will raise urine pH. Can you not use calcium foods at least in part? Otherwise you seem pretty good at changing things. Regards, Fred Coe

      Reply

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