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Shen Y, Luo X, Li H, Guan Q, Cheng L. Evaluation of a high-performance liquid chromatography method for urinary oxalate determination and investigation regarding the pediatric reference interval of spot urinary oxalate to creatinine ratio for screening of primary hyperoxaluria. J Clin Lab Anal 2021; 35:e23870. [PMID: 34097312 PMCID: PMC8373360 DOI: 10.1002/jcla.23870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Urinary oxalate can provide important clues for the screening and monitoring of children with primary hyperoxaluria (PH), which is a potentially life-threatening condition. However, little effort has been devoted to improve the oxalate assay in recent years. We have proposed a reliable and cost-effective high-performance liquid chromatography (HPLC) method for urinary oxalate determination. METHODS Urine specimens were centrifuged after one-step derivatization, and the supernatants were subjected to HPLC analysis. RESULTS The method was validated with consistent linearity from 0.0625 to 2.0 mmol/L with coefficients of variation ≤7.73%, good recovery, low carryover, satisfactory sample stability, and analytical specificity. The lower limit of quantification and the limit of detection were 0.03130 and 0.0156 mmol/L, respectively. Imprecision values were ≤2.92% and ≤16.6% for externally and internally produced controls, respectively. The pediatric reference interval of spot urinary oxalate to creatinine ratios was established together with its application in screening of PH in patients with renal diseases, revealing its successful deployment in our laboratory. CONCLUSIONS This reliable HPLC method could serve as a significant tool to determine urinary oxalate levels for screening and monitoring of children with PH in routine clinical laboratories.
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Affiliation(s)
- Ying Shen
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xia Luo
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huijun Li
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Guan
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liming Cheng
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Hashmi SB, Jafri L, Majid H, Talati J, Aziz W, Khan AH. Relationship of spot urine oxalate to creatinine ratio and 24 hours urinary oxalate excretion in patients with urolithiasis. Ann Med Surg (Lond) 2020; 60:330-333. [PMID: 33224485 PMCID: PMC7666312 DOI: 10.1016/j.amsu.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
Abstract
Background The evaluation of 24 h urinary oxalate excretion is the gold standard for diagnosing hyperoxaluria in patients with recurrent urolithiasis. However, 24 h urine sample collection is cumbersome. Therefore we aim to see if oxalate to creatinine ratio in random urine sample can be used as an alternative. Materials and methods A cross-sectional study was conducted at Section of Chemical Pathology, Department of Pathology and Laboratory Medicine Aga Khan University Karachi from 1st February to December 31, 2019. A total of 62 adult patients, 18–60 years of age with history of kidney stones presenting to the clinical laboratory for 24 h urine oxalate estimation were invited to participate in the study after informed consent. Clinical details were recorded on a structured questionnaire and patients were guided to submit 24 h urine and a random spot urine sample. Urinary oxalate was measured on Micro lab 300 using a kit based on oxalate oxidase principle by Trinity Biotech plc, Wicklow, Ireland following standard operating procedures. Urinary creatinine was measured on ADVIA 1800 by Siemens, US using kinetic Jaffe reaction according to the manufacturer's instructions. The data was analyzed on SPSS. Results In a period of ten months, a total of 62 subjects were recruited; mean age was 32.4 ± 2.6 years. Males were 49 (79.0%) and females were 13 (20.9%). Correlation was found to be (r = 0.289) by Spearman correlation (p value < 0.005). Taking 24 h urinary oxalate as gold standard the sensitivity, specificity, positive predictive value and negative predictive value of spot oxalate to creatinine ratio was 83.3%, 17.8%, 9.8% and 90.9% respectively. Conclusion The random spot urine test cannot replace the 24 h urinary oxalate estimation in patients with urolithiasis. Oxalate to creatinine ratio is proposed as an alternative to 24 h urine. Sensitivity & specificity of spot ox:cr ratio was 83.3% and 17.8% respectively. PPV and NPV of spot ox:cr ratio was 9.8% and 90.9% respectively. Studies taking diet and molecular testing into consideration are needed.
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Affiliation(s)
- Syed Bilal Hashmi
- Section of Chemical Pathology, Department of Pathology & Laboratory Medicine, Aga Khan University, Pakistan
| | - Lena Jafri
- Section of Chemical Pathology, Department of Pathology & Laboratory Medicine, Aga Khan University, Pakistan
| | - Hafsa Majid
- Section of Chemical Pathology, Department of Pathology & Laboratory Medicine, Aga Khan University, Pakistan
| | - Jamsheer Talati
- Section of Urology, Department of Surgery, Aga Khan University, Pakistan
| | - Wajahat Aziz
- Section of Urology, Department of Surgery, Aga Khan University, Pakistan
| | - Aysha Habib Khan
- Section of Chemical Pathology, Department of Pathology & Laboratory Medicine, Aga Khan University, Pakistan
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Demoulin N, Issa Z, Crott R, Morelle J, Danse E, Wallemacq P, Jadoul M, Deprez PH. Enteric hyperoxaluria in chronic pancreatitis. Medicine (Baltimore) 2017; 96:e6758. [PMID: 28489752 PMCID: PMC5428586 DOI: 10.1097/md.0000000000006758] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Chronic pancreatitis may lead to steatorrhea, enteric hyperoxaluria, and kidney damage. However, the prevalence and determinants of hyperoxaluria in chronic pancreatitis patients as well as its association with renal function decline have not been investigated.We performed an observational study. Urine oxalate to creatinine ratio was assessed on 2 independent random urine samples in consecutive adult patients with chronic pancreatitis followed at the outpatient clinic from March 1 to October 31, 2012. Baseline characteristics and annual estimated glomerular filtration rate (eGFR) change during follow-up were compared between patients with hyper- and normo-oxaluria.A total of 48 patients with chronic pancreatitis were included. The etiology of the disease was toxic (52%), idiopathic (27%), obstructive (11%), autoimmune (6%), or genetic (4%). Hyperoxaluria (defined as urine oxalate to creatinine ratio >32 mg/g) was found in 23% of patients. Multivariate regression analysis identified clinical steatorrhea, high fecal acid steatocrit, and pancreatic atrophy as independent predictors of hyperoxaluria. Taken together, a combination of clinical steatorrhea, steatocrit level >31%, and pancreatic atrophy was associated with a positive predictive value of 100% for hyperoxaluria. On the contrary, none of the patients with a fecal elastase-1 level >100 μg/g had hyperoxaluria. Longitudinal evolution of eGFR was available in 71% of the patients, with a mean follow-up of 904 days. After adjustment for established determinants of renal function decline (gender, diabetes, bicarbonate level, baseline eGFR, and proteinuria), a urine oxalate to creatinine ratio >32 mg/g was associated with a higher risk of eGFR decline.Hyperoxaluria is highly prevalent in patients with chronic pancreatitis and associated with faster decline in renal function. A high urine oxalate to creatinine ratio in patients with chronic pancreatitis is best predicted by clinical steatorrhea, a high acid steatocrit, and pancreatic atrophy. Further studies will need to investigate the mechanisms of renal damage in chronic pancreatitis and the potential benefits of therapies reducing oxaluria.
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Affiliation(s)
- Nathalie Demoulin
- Division of Nephrology, Cliniques universitaires Saint-Luc
- Institut de Recherche Expérimentale et Clinique
| | - Zaina Issa
- Division of Nephrology, Cliniques universitaires Saint-Luc
| | - Ralph Crott
- Institut de Recherche Santé et Société, Université catholique de Louvain
| | - Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc
- Institut de Recherche Expérimentale et Clinique
| | - Etienne Danse
- Institut de Recherche Expérimentale et Clinique
- Department of Radiology
| | - Pierre Wallemacq
- Institut de Recherche Expérimentale et Clinique
- Department of Clinical Chemistry
| | - Michel Jadoul
- Division of Nephrology, Cliniques universitaires Saint-Luc
- Institut de Recherche Expérimentale et Clinique
| | - Pierre H. Deprez
- Institut de Recherche Expérimentale et Clinique
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Dursun I, Çelik İ, Poyrazoglu HM, Köse K, Tanrıkulu E, Sahin H, Yılmaz K, Öztürk A, Yel S, Gündüz Z, Düşünsel R. Urinary oxalate to creatinine ratios in healthy Turkish schoolchildren. Ren Fail 2016; 39:146-152. [PMID: 27846788 PMCID: PMC6014300 DOI: 10.1080/0886022x.2016.1256308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim: we aimed to establish reference values for urinary oxalate to creatinine ratios in healthy children aged 6–15 years and to investigate the relationship between their nutritional habits and oxalate excretion. Materials and methods: Random urine specimens from 953 healthy children aged 6–15 years were obtained and analyzed for oxalate and creatinine. Additionally, a 24-h dietary recall form was prepared and given to them. The ingredient composition of the diet was calculated. The children were divided into three groups according to age: Group I (69 years, n = 353), Group II (10–12 years, n = 335), and Group III (13–15 years, n = 265). Results: The 95th percentile of the oxalate to creatinine ratio for subjects aged 6–9, 10–12, and 13–15 years were 0.048, 0.042, and 0.042 mg/mg, respectively. The oxalate to creatinine ratio was significantly higher in Group 1 than in Group 2 and Group 3. Urinary oxalate excretion was positively correlated with increased protein intake and negatively correlated with age. A significant positive correlation was determined between urinary oxalate excretion and the proline, serine, protein, and glycine content of diet. Dietary proline intake showed a positive correlation with the urine oxalate to creatinine ratio and was found to be an independent predictor for urinary oxalate. Conclusions: These data lend support to the idea that every country should have its own normal reference values to determine the underlying metabolic risk factor for kidney stone disease since regional variation in the dietary intake of proteins and other nutrients can affect normal urinary excretion of oxalate.
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Affiliation(s)
- Ismail Dursun
- a Department of Pediatric Nephrology , Erciyes University, Faculty of Medicine , Kayseri , Turkey
| | - İlknur Çelik
- b Department of Pediatrics , Erciyes University, Faculty of Medicine , Kayseri , Turkey
| | - Hakan M Poyrazoglu
- a Department of Pediatric Nephrology , Erciyes University, Faculty of Medicine , Kayseri , Turkey
| | - Kader Köse
- c Department of Biochemistry , Erciyes University, Faculty of Medicine , Kayseri , Turkey
| | - Esen Tanrıkulu
- c Department of Biochemistry , Erciyes University, Faculty of Medicine , Kayseri , Turkey
| | - Habibe Sahin
- d Department of Nutrition and Dietetics , Erciyes University, Atatürk Health School , Kayseri , Turkey
| | - Kenan Yılmaz
- a Department of Pediatric Nephrology , Erciyes University, Faculty of Medicine , Kayseri , Turkey
| | - Ahmet Öztürk
- e Department of Biostatistics , Erciyes University, Faculty of Medicine , Kayseri , Turkey
| | - Sibel Yel
- a Department of Pediatric Nephrology , Erciyes University, Faculty of Medicine , Kayseri , Turkey
| | - Zübeyde Gündüz
- a Department of Pediatric Nephrology , Erciyes University, Faculty of Medicine , Kayseri , Turkey
| | - Ruhan Düşünsel
- a Department of Pediatric Nephrology , Erciyes University, Faculty of Medicine , Kayseri , Turkey
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Edvardsson VO, Goldfarb DS, Lieske JC, Beara-Lasic L, Anglani F, Milliner DS, Palsson R. Hereditary causes of kidney stones and chronic kidney disease. Pediatr Nephrol 2013; 28:1923-42. [PMID: 23334384 PMCID: PMC4138059 DOI: 10.1007/s00467-012-2329-z] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 09/13/2012] [Accepted: 09/17/2012] [Indexed: 01/27/2023]
Abstract
Adenine phosphoribosyltransferase (APRT) deficiency, cystinuria, Dent disease, familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC), and primary hyperoxaluria (PH) are rare but important causes of severe kidney stone disease and/or chronic kidney disease in children. Recurrent kidney stone disease and nephrocalcinosis, particularly in pre-pubertal children, should alert the physician to the possibility of an inborn error of metabolism as the underlying cause. Unfortunately, the lack of recognition and knowledge of the five disorders has frequently resulted in an unacceptable delay in diagnosis and treatment, sometimes with grave consequences. A high index of suspicion coupled with early diagnosis may reduce or even prevent the serious long-term complications of these diseases. In this paper, we review the epidemiology, clinical features, diagnosis, treatment, and outcome of patients with APRT deficiency, cystinuria, Dent disease, FHHNC, and PH, with an emphasis on childhood manifestations.
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MESH Headings
- Adenine Phosphoribosyltransferase/deficiency
- Adenine Phosphoribosyltransferase/genetics
- Animals
- Child
- Cystinuria/diagnosis
- Cystinuria/epidemiology
- Cystinuria/genetics
- Cystinuria/therapy
- Dent Disease/diagnosis
- Dent Disease/epidemiology
- Dent Disease/genetics
- Dent Disease/therapy
- Genetic Predisposition to Disease
- Heredity
- Humans
- Hypercalciuria/diagnosis
- Hypercalciuria/epidemiology
- Hypercalciuria/genetics
- Hypercalciuria/therapy
- Hyperoxaluria, Primary/diagnosis
- Hyperoxaluria, Primary/epidemiology
- Hyperoxaluria, Primary/genetics
- Hyperoxaluria, Primary/therapy
- Kidney Calculi/diagnosis
- Kidney Calculi/epidemiology
- Kidney Calculi/genetics
- Kidney Calculi/therapy
- Metabolism, Inborn Errors/diagnosis
- Metabolism, Inborn Errors/epidemiology
- Metabolism, Inborn Errors/genetics
- Metabolism, Inborn Errors/therapy
- Nephrocalcinosis/diagnosis
- Nephrocalcinosis/epidemiology
- Nephrocalcinosis/genetics
- Nephrocalcinosis/therapy
- Phenotype
- Prognosis
- Renal Insufficiency, Chronic/diagnosis
- Renal Insufficiency, Chronic/epidemiology
- Renal Insufficiency, Chronic/genetics
- Renal Insufficiency, Chronic/therapy
- Renal Tubular Transport, Inborn Errors/diagnosis
- Renal Tubular Transport, Inborn Errors/epidemiology
- Renal Tubular Transport, Inborn Errors/genetics
- Renal Tubular Transport, Inborn Errors/therapy
- Risk Factors
- Urolithiasis/diagnosis
- Urolithiasis/epidemiology
- Urolithiasis/genetics
- Urolithiasis/therapy
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Illsinger S, Lücke T, Vaske B, Schmidt KH, Bohnhorst B, Das AM. Developmental changes of oxalate excretion in enterally fed preterm infants. J Inherit Metab Dis 2009; 32:102-8. [PMID: 19067228 DOI: 10.1007/s10545-008-1024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 10/14/2008] [Accepted: 10/20/2008] [Indexed: 10/21/2022]
Abstract
To further substantiate gestational age-related changes in oxalate excretion, we studied urinary oxalate excretion in 66 preterm infants born at 23.4-34.7 weeks of gestation. Spot urine of 66 preterm infants was analysed by ion chromatography as soon as they were completely orally fed with enriched breast milk and/or special preterm milk formula (days 7 to 57 of postnatal life). Infants with evidence of renal, gastrointestinal, muscular or metabolic disease were not included. Newborns on parenteral nutrition were excluded. Oxalate/creatinine ratios (Ox/Cr) decreased with gestational age (three age groups: group 1, 23 0/7-28 0/7; group 2, 28 1/7-32 0/7; and group 3, 32 1/7-35 0/7 weeks of gestation). The mean Ox/Cr was highest in group 1 (398.2 mmol/mol +/- 116.8; n = 21). Differences between groups 1 + 3 were statistically significant; p = 0.001; those between groups 1 + 2 and between groups 2 + 3 were not. Ox/Cr correlated inversely with gestational and maturational age (r = -0.41, p = 0.001; r = -0.33, p = 0.007) and positively with postnatal age (r = 0.32, p = 0.008). It correlated inversely with birth weight as well as actual weight at sample collection (r = -0.46 and -0.44, p < 0.001). Ox/Cr was significantly linked to energy and carbohydrate intake (r = 0.3 and 0.4, p = 0.03 and 0.001). These results were independent of sex. In the present study we show that urinary oxalate excretion in preterm infants depends on gestational age.
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Affiliation(s)
- S Illsinger
- Department of Paediatric Kidney-, Liver- and Metabolic Diseases, Children's Hospital, Hannover Medical School, Hannover, Germany
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Ladwig PM, Liedtke RR, Larson TS, Lieske JC. Sensitive spectrophotometric assay for plasma oxalate. Clin Chem 2006; 51:2377-80. [PMID: 16306102 DOI: 10.1373/clinchem.2005.054353] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Paula M Ladwig
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Reusz GS, Dobos M, Byrd D, Sallay P, Miltényi M, Tulassay T. Urinary calcium and oxalate excretion in children. Pediatr Nephrol 1995; 9:39-44. [PMID: 7742220 DOI: 10.1007/bf00858966] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We have established normal values for calcium/creatinine (Ca/Cr) and oxalate/creatinine (Ox/Cr) ratios in 25 infants (aged 1-7 days) and 391 children (aged 1 month to 14.5 years) and compared these with values obtained in 137 children with post-glomerular haematuria and 27 with nephrolithiasis. Oxalate was measured by ion chromatography. Nomograms of Marshall and Robertson were used to calculate urine saturation to calcium oxalate. The Ca/Cr ratio was normally distributed whereas the Ox/Cr ratio had a log-normal distribution. The molar ratio of Ca/Cr was the lowest in the first days of life and the highest between 7 month and 1.5 years (mean +/- SD = 0.39 +/- 0.28 mmol/mmol). Following a slight decrease it stabilised by the age of 6 years (0.34 +/- 0.19 mmol/mmol). The highest Ox/Cr values were measured during the 1st month of life [geometric mean 133 (range 61-280) mumol/mmol], followed by a gradual decrease until 11 years of age [mean 24 (range 6-82) mumol/mmol]. Thirty-six haematuric children had hypercalciuria (26%), 23 had absorptive hypercalciuria, 13 renal type. Children with absorptive hypercalciuria on a calcium-restricted diet had significantly higher oxalate excretion than those with renal hypercalciuria and the control group [38 (range 28-49) vs. 22 (range 16-29) and 23 (range 22-27) mumol/mol respectively, P < 0.01]. Calcium oxalate urine saturation of stone patients was higher than that of patients with haematuria and the normal population (1.18 +/- 0.05 vs. 1.06 +/- 0.03, P < 0.03 and 0.84 +/- 0.03, P < 0.001 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G S Reusz
- First Department of Paediatrics, Semmelweis University Medical School, Budapest, Hungary
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