Reference range of random urinary calcium creatinine ratio in North Indian children and adolescents

Abstract

Purpose: Urinary calcium creatinine ratio (UCaCrR) is a reliable indicator for monitoring hypercalciuria following vitamin D supplementation. However, the reference range varies from region to region. Previous studies did not take vitamin D and parathyroid hormone status into account while evaluating UCaCrR. Hence, we undertook this study to establish the 95th percentile of UCaCrR as an indicator of hypercalciuria in North Indian children and adolescents. Methods: Four hundred seventy-three participants (boys 62.2%, girls 37.8%) with adequate dietary calcium intake, normal serum levels of 25-hydroxy-vitamin D (>20 ng/mL), and without secondary hyperparathyroidism following supplementation were selected for evaluation of UCaCrR. Results: The mean age and body mass index of subjects were 11.2±2.6 years and 18.0±3.6 kg/m 2 , respectively. The 95th percentile of UCaCrR in the study population was 0.126. The mean, median, and 95th percentile of UCaCrR was significantly higher in prepubertal children (age ≤10 years) (0.0586±0.0374, median=0.0548, 95th percentile=0.136) compared to those >10 years old (0.0503±0.0363, median=0.0407, 95th percentile=0.123, P=0.02). No significant difference in UCaCrR was observed between genders and different weight categories. Conclusion: UCaCrR of 0.13 defines the cutoff value for hypercalciuria in North Indian children and adolescents with adequate dietary intake of calcium and sufficient serum vitamin D levels.

Diagnosis and management of X-linked hypophosphatemia in children and adolescent in the Gulf Cooperation Council countries

“…In contrast, urine calcium excretion is decreased in all types of calcipenic rickets and increased in hereditary hypophosphatemic rickets with hypercalciuria and in conditions associated with renal Fanconi syndrome, for example, cystinosis. Increased urinary albumin and low molecular weight protein excretion (alpha-1 microglobulin, beta-2-microalbumin, retinol-binding protein) might be a clue to Dent's disease-the urine dipsticks test may be negative as it detects albumin rather than low molecular weight protein [50][51][52][53][54]. Patients with VDDR1B will have low serum 25OHD levels due to biallelic mutation in the CYP2R1 gene, which encodes for the main hepatic 25-hydroxylase [30,31,58].…”

“…In patients with XLH, PHEX mutations increase plasma levels of both intact FGF23 and C-terminal FGF23 levels. However, we are aware of genetically confirmed XLH patients with plasma FGF23 levels within the normal range, which should be interpreted as inappropriately normal in the setting of hypophosphatemia [ 53 , 54 ]. Patients with tumor-induced osteomalacia have very high plasma levels of FGF23 [ 31 ].…”

Calcium status assessment at the population level: Candidate approaches and challenges

“…The majority of studies suggest using the first‐morning urine spot sample collected in order to assess UCa/Cr since it is easy to collect and correlates well with 24‐h urinary calcium excretion. However, UCa/Cr has low sensitivity for detecting adequate calcium intake, and reference ranges based on race and age are required to interpret the data 59,60 …”

“…However, UCa/Cr has low sensitivity for detecting adequate calcium intake, and reference ranges based on race and age are required to interpret the data. 59 , 60 …”

Application of a six sigma model to evaluate the analytical performance of urinary biochemical analytes and design a risk‐based statistical quality control strategy for these assays: A multicenter study

“…[1][2][3][4][5] The levels of K, Na, Cl, Ca, and P reflect the excretion and reabsorption functions of the kidneys. 6,7 The detection of GLU levels is mainly used for the auxiliary diagnosis of diabetes. 8 The levels of urea, Crea, TP, and mALB mainly reflect the degree of kidney damage caused by various diseases.…”