Cinical Investigation

Kidney International (1986) 30, 85–90; doi:10.1038/ki.1986.155

A urinary calcium–citrate index for the evaluation of nephrolithiasis

Joan H Parks1 and Fredric L Coe1

1Renal Program, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA

Correspondence: J H Parks, Box 28, University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, Chicago, Illinois 60637, U.S.A.

Received 23 September 1985; Revised 16 December 1985.

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Abstract

A urinary calcium–citrate index for the evaluation of nephrolithiasis. We have performed a multivariate analysis of urine abnormalities in patients with calcium oxalate nephrolithiasis, in which effects of gender were also considered. The characteristic of patients that most clearly sets them apart from normal people is a high level of urine calcium for any given level of urine citrate. Other urine measurements cannot improve upon the separation between patients and normals provided by urine calcium and citrate, and their abnormal relationship to each other. Normal women have higher urine citrate and lower urine calcium than normal men or patients of either sex; normal men differ from stone forming men only moderately. Direct measurements of supersaturation are not helpful in distinguishing between patients and normals, once calcium and citrate have been considered. From our analysis, we have derived a new index for evaluating the significance of urine calcium and citrate levels that seems to offer a better basis for clinical diagnosis than criteria presently in use.

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