Urinary Calcium (Spot)

Kidney

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No Fasting Required

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Measures urinary calcium.

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Urinary Calcium (Spot) - Comprehensive Test Guide

Why is it done?
- Measures the amount of calcium present in a single urine sample to assess calcium metabolism and kidney function
- Diagnoses hypercalciuria (abnormally high urinary calcium) which may indicate kidney stones, bone disease, or metabolic disorders
- Evaluates patients with recurrent kidney stones, hypercalcemia, or osteoporosis
- Assesses parathyroid function and vitamin D metabolism disorders
- Monitors treatment effectiveness in patients with calcium-related disorders
- Investigates causes of kidney dysfunction or abnormal serum calcium levels
Normal Range
- Reference Range: Typically 100-300 mg/24 hours for 24-hour collection; for spot urine: <300 mg/L or <7.5 mmol/L
- Units: mg/24 hours, mg/L, or mmol/L (varies by laboratory)
- Low Results: <100 mg/24 hours may indicate hypocalcemia, malabsorption, vitamin D deficiency, or poor dietary calcium intake
- High Results: >300 mg/24 hours (hypercalciuria) may indicate hyperparathyroidism, hypervitaminosis D, kidney stones, bone disease, or excessive dietary calcium
- Normal Significance: Normal results generally indicate appropriate calcium metabolism and kidney function, though interpretation depends on clinical context and other serum markers
Interpretation
- Elevated Urinary Calcium (Hypercalciuria): May indicate primary hyperparathyroidism, hyperthyroidism, vitamin D toxicity, sarcoidosis, Paget's disease, multiple myeloma, immobilization, or excessive dietary calcium and sodium intake. Risk factor for kidney stone formation.
- Low Urinary Calcium (Hypocalciuria): May indicate hypoparathyroidism, vitamin D deficiency, chronic kidney disease, malabsorption syndromes, or inadequate dietary calcium intake. May reflect kidney's appropriate response to low serum calcium.
- Factors Affecting Results: Dietary intake (sodium and protein increase urinary calcium), medications (diuretics, corticosteroids), hydration status, time of day, age, sex, and metabolic state significantly influence measurements
- Spot vs. 24-Hour Collections: Spot urine calcium is more convenient but less accurate than 24-hour collection. Often adjusted for creatinine to account for urine dilution. Urine calcium-to-creatinine ratio (UCCR) is frequently used: normal <0.2 mg/mg or <200 µmol/mmol
- Clinical Patterns: Combined with serum calcium, phosphate, and PTH levels provides comprehensive metabolic assessment. Results must be interpreted within overall clinical picture and patient's symptoms
Associated Organs
- Primary Organ Systems: Kidneys (filtration and reabsorption), parathyroid glands (PTH regulation), bones (calcium reservoir), and gastrointestinal tract (calcium absorption)
- Associated Conditions: Nephrolithiasis (kidney stones), chronic kidney disease, acute kidney injury, hyperparathyroidism, hypoparathyroidism, osteoporosis, osteopenia, vitamin D deficiency, hypercalcemia, hypocalcemia
- Metabolic Disorders: Sarcoidosis, thyrotoxicosis, Paget's disease, multiple myeloma, lymphomas, granulomatous diseases, idiopathic hypercalciuria
- Complications of Abnormal Results: High levels increase risk of kidney stone formation, nephrocalcinosis, renal damage, and progression to chronic kidney disease. Low levels may lead to hypocalcemia complications including tetany, seizures, and cardiac arrhythmias
- Medication Effects: Thiazide diuretics decrease urinary calcium; loop diuretics increase it. Glucocorticoids, vitamin D supplements, and thyroid hormones increase urinary calcium excretion
Follow-up Tests
- If Results are Elevated: Serum calcium, serum phosphate, parathyroid hormone (PTH), vitamin D (25-hydroxyvitamin D and 1,25-dihydroxyvitamin D), alkaline phosphatase, urine pH, 24-hour urinary calcium, urine uric acid, urine citrate, serum magnesium, abdominal ultrasound or CT scan to detect kidney stones
- If Results are Low: Serum calcium, serum albumin, phosphate, magnesium, PTH, vitamin D levels, assessment of kidney function (creatinine, eGFR), bone-specific alkaline phosphatase, assessment for malabsorption disorders
- Imaging Studies: Renal ultrasound or non-contrast CT (KUB) for kidney stones, bone density scan (DEXA) for osteoporosis evaluation if indicated
- Monitoring Frequency: Recurrent kidney stone formers may need semi-annual to annual monitoring. Patients on calcium supplementation or vitamin D therapy require periodic reassessment. Those with metabolic disorders need testing based on disease progression and treatment response
- Complementary Tests: Urine electrolytes (sodium, potassium), urine creatinine for ratio calculations, bone turnover markers, metabolic bone disease panel, comprehensive metabolic panel (CMP)
Fasting Required?
- Fasting: No
- Sample Collection: Single spot urine sample collected anytime during the day, typically mid-stream clean-catch method. No special timing required.
- Special Preparation: For 24-hour collection (alternative test): Collect all urine over 24 hours starting with first morning void; discard initial specimen and begin collection with next void. Continue through next morning's first void.
- Medications - Do Not Hold: Continue all regular medications unless specifically instructed by physician. Diuretics, calcium supplements, vitamin D, and corticosteroids should generally continue, though results must account for medication effects.
- Dietary Considerations: For accurate results, stable diet for 3-5 days before testing is recommended. Avoid excessive dietary calcium, sodium, and protein immediately before test. Maintain adequate hydration (normal fluid intake). For 24-hour collection, consistent activity level and hydration throughout collection period is important.
- Container Requirements: Use sterile collection cup for spot sample. For 24-hour collection, use acid-preservative bottle (typically containing HCl) as provided by laboratory. Keep specimen refrigerated or on ice during collection.

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