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When a patient needs a metabolic evaluation for kidney stones the twnety-four hour urine should include at minimum:
- Calcium
- Oxalate
- Citrate
- Uric Acid
- Volume
- pH
- Creatinine
- Sodium
- Potassium
- Chloride
- Urea nitrogen
- Phosphorous
- Magnesium
- Ammonia
- Sulfate
Urine oxalate over 90 mg/day should trigger an evaluation for enteric hyperoxaluria or primary hyperoxaluria.
Hypocitraturia is defined as a citrate below 325mg/day. Hypokalemia can trigger hypocitraturia (along with metabolic acidosis) so be careful when prescribing a thiazide for hypercalciuria, the resulting hypokalemia could surpress citrate and increase rather than lower the risk of developing a kidney stone.
While bowel disease is usually associated with calcium oxalate stones, patients often have decreased urine pH which predisposes them to uric acid stones.