Sensitivity and specificity of 24-hour urine chemistry levels for detecting elevated calcium oxalate and calcium phosphate supersaturation

Authors

  • M. Adrian Rossi Department of Urology, University of Rochester Medical Center, Rochester, NY
  • Eric A. Singer Department of Urology, University of Rochester Medical Center, Rochester, NY
  • Dragan J. Golijanin Department of Urology, University of Rochester Medical Center, Rochester, NY
  • Rebeca D. Monk Division of Nephrology, University of Rochester Medical Center, Rochester, NY
  • Erdal Erturk Department of Urology, University of Rochester Medical Center, Rochester, NY
  • David A. Bushinsky Division of Nephrology, University of Rochester Medical Center, Rochester, NY

DOI:

https://doi.org/10.5489/cuaj.511

Abstract

Objectives: The gold standard for determining likelihood of calcium oxalate
(CaOx) and calcium phosphate (CaPhos) stone formation in urine is supersaturation
of CaOx and CaPhos. Our objective was to investigate whether traditional
measurement of total calcium, oxalate and phosphate in a 24-hour urine
collection is sufficiently sensitive and specific for detecting elevated supersaturation
to preclude the more expensive supersaturation test.

Methods: We performed a retrospective review of 150 consecutive patients with
nephrolithiasis who underwent measurement of CaOx supersaturation (CaOxSS)
and CaPhos supersaturation (CaPhosSS), as well as total calcium, oxalate and
phosphate in a 24-hour urine collection. We used various cut-off values to determine
sensitivity and specificity of 24-hour urine measurements for detecting
elevated CaOxSS and CaPhosSS.

Results: In men and women, the sensitivity of 24-hour calcium for detecting
elevated CaOxSS was 71% and 79%, respectively; for oxalate, sensitivity was
59% and 36%, respectively. In men and women, the sensitivity of 24-hour calcium
for detecting elevated CaPhosSS was 74% and 88%, respectively; for phosphate,
sensitivity was 57% and 8%, respectively. In men and women, the specificity
of 24-hour calcium for detecting elevated CaOxSS was 55% and 48%,
respectively; it was 60% for detecting elevated CaPhosSS in both men and
women.

Conclusion: Traditional 24-hour urine analysis is sensitive, but not specific, for
detecting elevated CaOxSS and CaPhosSS. Most patients with abnormal 24-
hour urine analysis have normal supersaturation, and treatment decisions based
on traditional urine analysis would lead to overtreatment in these patients.

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Author Biographies

M. Adrian Rossi, Department of Urology, University of Rochester Medical Center, Rochester, NY

Eric A. Singer, Department of Urology, University of Rochester Medical Center, Rochester, NY

Dragan J. Golijanin, Department of Urology, University of Rochester Medical Center, Rochester, NY

Rebeca D. Monk, Division of Nephrology, University of Rochester Medical Center, Rochester, NY

Erdal Erturk, Department of Urology, University of Rochester Medical Center, Rochester, NY

David A. Bushinsky, Division of Nephrology, University of Rochester Medical Center, Rochester, NY

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How to Cite

Rossi, M. A., Singer, E. A., Golijanin, D. J., Monk, R. D., Erturk, E., & Bushinsky, D. A. (2013). Sensitivity and specificity of 24-hour urine chemistry levels for detecting elevated calcium oxalate and calcium phosphate supersaturation. Canadian Urological Association Journal, 2(2), 117–22. https://doi.org/10.5489/cuaj.511

Issue

Vol. 2 No. 2 (2008): CUAJ April

Section

Original Research

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