Variations between two 24-hour urine collections in patients

Abstract

Introduction: The current Canadian Urological Association (CUA) guideline recommends two 24-hour urine collections in the metabolic evaluation for patients with urolithiasis. The aim of the present study was to compare two consecutive 24-hour urine collections in patients with a history of urolithiasis presenting to a tertiary stone clinic. Methods: We retrospectively reviewed 188 patients who had two 24-hour collections upon presentation between January 2010 and December 2010. Samples were collected on consecutive days and examined for the following 11 urinary parameters: volume, creatinine, sodium, calcium, uric acid, citrate, oxalate, potassium, phosphorous, magnesium and urea nitrogen. For each parameter, the absolute value of the difference between the two samples rather than the direct difference was compared with zero. Similarly, the percent difference between samples was calculated for each parameter. Results: The means of the absolute differences between the two samples were significantly different for all 11 urinary parameters (p < 0.0001). The percent differences for all urinary parameters ranged from 20.5% to 34.2%. Furthermore, 17.1% to 47.6% of patients had a change from a value within normal limits to an abnormal value, or vice-versa. Significance was maintained when patients with incomplete or over-collections were excluded. Conclusions: Significant variations among the two 24-hour urine collections were observed in all of the 11 urinary parameters analyzed. This variation may change clinical decision-making in up to 47.6% of patients if only a single 24-hour urine collection is obtained. The present study supports the CUA guideline of performing two 24-hour urine collections.

Combined vitamin D and calcium supplementation in vitamin D inadequate patients with urolithiasis: Impact on hypercalciuria and de novo stone formation

“…7 Whereas the latter study used a single 24-hour urine collection, in the present study two 24-hour urine collections were used to get a better representative sampling of the urinary parameters as recommended by the Canadian Urology Association guidelines. 13,14 On the other hand, the study by Berlin and colleagues found that patients with high urinary calcium excretion (>6.0 mmol/L) had significantly higher levels of serum 25(OH)VD than those with a lower urinary calcium. 15 However, patients were prescribed neither VD nor calcium supplements.…”

Metabolic Evaluation and Recurrence Prevention for Urinary Stone Patients: EAU Guidelines

“…Specific metabolic evaluation requires collection of two consecutive 24-h urine samples [13,14]. Patients should remain on a self-selected diet [15].…”

CUA guideline on the evaluation and medical management of the kidney stone patient ‒ 2016 update

“…21,22 Recent data suggests that up to 47.6% of patients had their clinical management changed by an abnormality that was identified only when two samples were collected. 23,24 It is currently recommended that two 24-hour urine collections be obtained in order to correctly identify metabolic abnormalities. The benefit of two collections should be balanced, however, by the practicality and importance of obtaining at least one collection (Level of Evidence 3, Grade C Recommendation).…”