Urinary citrate excretion in the diagnosis of distal renal tubular acidosis

Norman, Michael E.; Feldman, Nathan I.; Cohn, Roy; Roth, Karl S.; McCurdy, Donna K.

doi:10.1016/s0022-3476(78)80426-0

Cited by 115 publications

(46 citation statements)

References 22 publications

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“…Because of the fact that we found a weak inverse correlation between U Cit/Cr and age, we further analyzed the data dividing controls into two groups based on median age of 9.75; the 5th percentile of U Cit/Cr in those younger than 9.75 was 178.6 mg/g while in the older subjects it was 145.8 mg/g indicating that in pediatric age groups U Cit/Cr Ͼ180 mg/g can be regarded as normal. Indeed, Norman et al (23) found urine citrate/creatinine to be Ͻ75 mg/g in nine children with complete and incomplete distal renal tubular acidosis. On the other hand, using the reference value of 400 mg/g as was recently done by VanDervoort et al (1) would have rendered 25% of our control population and 44.3% of our stone formers as hypocitraturic.…”

Section: Discussionmentioning

confidence: 99%

Urine Calcium/Citrate Ratio in Children With Hypercalciuric Stones

et al. 2009

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Hypercalciuria is a common cause for stone formation in children. The aim was to delineate the role of urinary citrate in hypercalciuric children for protection against calcium stone formation. We evaluated random urine calcium, citrate, and creatinine in 149 controls, 78 hypercalciuric nonstone formers, and 34 hypercalciuric children with stone. Urine citrate/creatinine was highest in hypercalciuric nonstone formers 899 Ϯ 351 compared with controls 711 Ϯ 328 and stone formers 595 Ϯ 289 (p Ͻ 0.01 vs. both). Calcium/creatinine ratio was similar in hypercalciuric stone and nonstone formers, but significantly higher than controls. Consequently, urine Calcium/citrate ratio (mg/mg) increased from control 0.17 Ϯ 0.17 to 0.41 Ϯ 0.23 (p Ͻ 0.001) in hypercalciuric nonstone formers, and to 0.65 Ϯ 0.46 in stone formers (p Ͻ 0.001 compared with other groups). Area under receiver operating characteristic curve combined with multilevel risk analyses found calcium/citrate ratio of 0.326 to provide good discrimination between control and stone formers. We found 5th percentile for random urine citrate/creatinine ratio in school-aged children to be 176 mg/g, elevated urinary citrate excretion in hypercalciuric children to be protective against stone formation, and urine calcium/citrate ratio to be a good indicator for risk of stone formation. Whether intervention in hypercalciuric children to lower urine calcium/citrate Ͻ0.326 will provide protection against stone formation needs to be studied. (Pediatr Res 66: 85-90, 2009) T he incidence of urolithiasis in children has increased in recent years (1). The risk factors for urolithiasis commonly observed in children are low urine volume, increased urine calcium excretion, and low normal or decreased urinary citrate level (2). Citrate inhibits the spontaneous nucleation of calcium oxalate, crystal growth of calcium oxalate and calcium phosphate, and the heterogeneous nucleation of calcium oxalate by monosodium urate (3-8). Bisaz et al. (9) reported that citrate is responsible for 50% of the inhibitory activity against calcium phosphate precipitation in normal urine. The inhibitory effect of citrate on calcium oxalate crystal growth and aggregation is also linked to a direct effect on the crystal surface (3,10). Consequently, and because of lack of significant adverse effects, citrate preparations are widely used in subjects with calcium oxalate nephrolithiasis (2,11-13).In adult studies, Welshman and McGeown (14), Hobarth and Hofbauer (15) and Nikkila et al. (16) observed that urine calcium/citrate ratio was able to discriminate between stone formers and control population; the latter exhibiting a significantly lower calcium/citrate ratio. However, it was the impression in the above studies that the clinical use of urine calcium/citrate ratio was limited because of its wide range of variability and the influence of age and gender on urinary excretion of citrate. There is limited data on urine calcium/ citrate ratio in either healthy, hypercalciuric, or stone forming child...

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Section: Discussionmentioning

confidence: 99%

Urine Calcium/Citrate Ratio in Children With Hypercalciuric Stones

et al. 2009

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“…Although these patients cannot acidify the urine, a high rate of NH 4 ϩ excretion compensates for their limited excretion of titrable acid. Some cases have been reported as a result of screening for hypocitraturia in families of a propositus with complete distal RTA (18).…”

Section: Distal Rta (Type 1)mentioning

confidence: 99%

Renal Tubular Acidosis

Soriano¹

2002

Journal of the American Society of Nephrology

398

166

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“…So we believe our patient develop nephrocalcinosis secondary to hyperoxalruia and later contributed by distal RTA. He had urolithiasis due to hyperoxaluria, hypercalciuria and hypocitrateuria [9] caused by distal RTA, and hyperuricemia caused by CKD. His urine stone analysis was positive for calcium, oxalate.…”

Section: Discussionmentioning

confidence: 99%

Delayed Presentation of Short Bowel Syndrome Complicated with Severe Degree of Nutritional Deficiencies, Nephrocalcinosis and Distal Renal Tubular Acidosis

Herath¹,

Kulatunga²

2017

J Gastrointest Dig Syst

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Background: Short bowel syndrome (SBS) is a malabsorptive state due to functional or anatomic loss of extensive segments of small intestine which can lead to nutritional deficiencies and metabolic disarrangements. Here we describe a young patient with short bowel presenting with severe nutritional deficiencies, nephrocalcinosis and distal renal tubular acidosis. Nephrocalcinosis and distal renal tubular acidosis are closely associated and each can lead to the other. There are only rare case reports of short bowel syndrome complicated with nephrocalcinosis and distal RTA and severe degree of metabolic derangement with nutritional deficiencies. And this case highlights the importance of early management of short bowel syndrome in order to prevent long-term complications.

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Urinary citrate excretion in the diagnosis of distal renal tubular acidosis

Cited by 115 publications

References 22 publications

Urine Calcium/Citrate Ratio in Children With Hypercalciuric Stones

Urine Calcium/Citrate Ratio in Children With Hypercalciuric Stones

Renal Tubular Acidosis

Delayed Presentation of Short Bowel Syndrome Complicated with Severe Degree of Nutritional Deficiencies, Nephrocalcinosis and Distal Renal Tubular Acidosis

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