My Lab Report

IMG_2303

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

61
Leave a Reply

avatar
21 Comment threads
40 Thread replies
1 Followers
 
Most reacted comment
Hottest comment thread
23 Comment authors
Fredric Coe, MDAliceKenDavid TaylorJustin Recent comment authors

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  Subscribe  
Notify of
Ken
Guest
Ken

Hi Dr. Coe, would welcome your thoughts on the following from Litolink which I received today; I starred the items that are listed as outliers (will have a followup appt with my urologist in another 6 weeks) – Have had stones for about 7 years or so, with the frequency increasing over the past 1-2 years

Volume 3.7
SS CaOx 4.24
Urine Calcium 135
Urine Oxalate 91*
Urine Citrate 829
SS CaP 0.64
pH 6.954*
SS Uric Acid 0.09
Urine Uric Acid 1.177*

Dietary Factors:
Na 150
K 194
Mg 117
P 0.934
Nh4 55
Cl 199
Sul 45
UUN 18.82*
PCR 1.5*

Normalized Values:
Cr24 2995
Cr24/kg 32.2*
Ca24/Kg 1.5
Ca24/cr24 45

Thanks!

David Taylor
Guest
David Taylor

Dr. Coe; Could you give me your opinion on my 24 hour urine results. A little history: I am 59 years old and have had Calcium Oxolate stones since the mid 1980’s. At that time I was told I have MSK in my left kidney..all of my stones come from the left kidney, right one never shoes any on scans. In the late 1990’s, I was diagnosed with Ulcerative Colitis. I’ve only had one “flare-up” since then and it is easily brought under control with medicine. I currently take no medicine for this. Here are my results. Thanks. Volume 3.09… Read more »

Justin
Guest
Justin

Sorry, slight glitch in my comment from a few minutes ago: the end of the paragraph after the first batch of numbers should read “With SS CaOx under 3.0, Ca 24 of 51 and Ox 24 of 30, isn’t it a bit ridiculous that I would consistently form these large crops of CaOx stones? I know that crystal formation becomes possible at any SS over 1.0, but these numbers seem highly unusual for such a prolific stone former as I am.” Alas, the script that processes the comments doesn’t seem to be able to deal with less than/greater than signs.

Justin
Guest
Justin

Dr. Coe and colleagues, I must first extend my deepest thanks for all of your stunning work throughout this website. It is truly a one-of-a-kind resource for patients (and probably not a few doctors!), and your passion for the subject shines through on every page. From the bottom of my heart, thank you. I apologize in advance for the length of this comment; much of it consists of test results that you may skip or skim as appropriate, and I have tried to keep the rest as brief as possible. I am a patient presenting with a recurring CaOx stone… Read more »

Stephanie
Guest
Stephanie

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

jharris
Editor

Hi Stephanie,

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

Jill

Patti
Guest
Patti

I got my results back from Litholink on my 24 hour urine. I am confused as to whether or not I should be taking Calcium. My urine volume was very low at 0.69, SS CaOx is 14.70, not a typo. Urine calcium is 127. Urine oxalate is 38. Urine citrate is 958. SS CaP is 3.95. Urine ph is 6.752. SS uric acid is 0.28. Sodium is 120. The Nurse Practitioner called today and said to just drink more fluids. I am thinking based on these results that I should be on a low oxalate diet and increase fluids. I… Read more »

James
Guest
James

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

google
Guest

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

Wayne Lee
Guest
Wayne Lee

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

Kelly Stanley
Guest
Kelly Stanley

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