Ann Pediatr Endocrinol Metab.  2019 Mar;24(1):34-40. 10.6065/apem.2019.24.1.34.

Reference range of random urinary calcium creatinine ratio in North Indian children and adolescents

Affiliations
  • 1Department of Endocrinology and Thyroid Research Centre, INMAS, DRDO, Delhi, India. marwaha_ramank@hotmail.com
  • 2Department of Medicine & Endocrinology, All India Institute of Medical Sciences, Jodhpur, India.
  • 3Dang Laboratory, New Delhi, India.
  • 4Department of Endocrinology, Medanta Hospital, Medicity, Gurugram, India.
  • 5Department of Medicine, Dr B R Sur Homeopathic Medical College, New Delhi, India.
  • 6Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India.
  • 7Central Council of Homeopathic Research, New Delhi, India.

Abstract

PURPOSE
Urinary calcium creatinine ratio (UCaCrR) is a reliable indicator for monitoring hypercalciuria following vitamin D supplementation. However, the reference range varies from region to region. Previous studies did not take vitamin D and parathyroid hormone status into account while evaluating UCaCrR. Hence, we undertook this study to establish the 95th percentile of UCaCrR as an indicator of hypercalciuria in North Indian children and adolescents.
METHODS
Four hundred seventy-three participants (boys 62.2%, girls 37.8%) with adequate dietary calcium intake, normal serum levels of 25-hydroxy-vitamin D (>20 ng/mL), and without secondary hyperparathyroidism following supplementation were selected for evaluation of UCaCrR.
RESULTS
The mean age and body mass index of subjects were 11.2±2.6 years and 18.0±3.6 kg/m2, respectively. The 95th percentile of UCaCrR in the study population was 0.126. The mean, median, and 95th percentile of UCaCrR was significantly higher in prepubertal children (age ≤10 years) (0.0586±0.0374, median=0.0548, 95th percentile=0.136) compared to those >10 years old (0.0503±0.0363, median=0.0407, 95th percentile=0.123, P=0.02). No significant difference in UCaCrR was observed between genders and different weight categories.
CONCLUSIONS
UCaCrR of 0.13 defines the cutoff value for hypercalciuria in North Indian children and adolescents with adequate dietary intake of calcium and sufficient serum vitamin D levels.

Keyword

Urinary calcium creatinine ratio; Children and adolescents; Weight category

MeSH Terms

Adolescent*
Body Mass Index
Calcium*
Calcium, Dietary
Child*
Creatinine*
Female
Humans
Hypercalciuria
Hyperparathyroidism, Secondary
Parathyroid Hormone
Reference Values*
Vitamin D
Calcium
Calcium, Dietary
Creatinine
Parathyroid Hormone
Vitamin D

Figure

  • Fig. 1. Consortium flow diagram. 25OHD, 25-hydroxy-vitamin D; PTH, parathyroid hormone; RDA, recommended daily allowance; ICMR, Indian Council of Medical Research.

  • Fig. 2. Scatter plot showing correlation between urinary calcium creatinine ratio and serum 25-hydroxy-vitamin D (25OHD) (A), parathyroid hormone (B), and dietary calcium (C). Lines denote a linear correlation with mean confidence interval.


Reference

References

1. Leslie SW, Taneja A. Hypercalciuria. Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing;2017 Dec 14 [updated 2018 Dec 6]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448183/.
2. Miyai K, Onishi T, Kashimada K, Hasegawa Y. Urinary calcium to creatinine ratio: a potential marker of secondary hyperparathyroidism in patients with vitamin D-dependent rickets type 1A. Endocr J. 2015; 62:61–8.
Article
3. Metz MP. Determining urinary calcium/creatinine cut-offs for the paediatric population using published data. Ann Clin Biochem. 2006; 43(Pt 5):398–401.
Article
4. Ring E, Borkenstein M. Use of the calcium-creatinine ratio in diagnosis and therapy. Padiatr Padol. 1987; 22:245–50.
5. Sönmez F, Akçanal B, Altincik A, Yenisey C. Urinary calcium excretion in healthy Turkish children. Int Urol Nephrol. 2007; 39:917–22.
Article
6. Vachvanichsanong P, Lebel L, Moore ES. Urinary calcium excretion in healthy Thai children. Pediatr Nephrol. 2000; 14:847–50.
Article
7. So NP, Osorio AV, Simon SD, Alon US. Normal urinary calcium/creatinine ratios in African-American and Caucasian children. Pediatr Nephrol. 2001; 16:133–9.
Article
8. Ceran O, Akin M, Aktürk Z, Ozkozaci T. Normal urinary calcium/creatinine ratios in Turkish children. Indian Pediatr. 2003; 40:884–7.
9. Sargent JD, Stukel TA, Kresel J, Klein RZ. Normal values for random urinary calcium to creatinine ratios in infancy. J Pediatr. 1993; 123:393–7.
Article
10. El Mallah C, Ghattas H, Shatila D, Francis S, Merhi K, Hlais S, et al. Urinary magnesium, calcium, and phosphorus to creatinine ratios of healthy elementary school lebanese children. Biol Trace Elem Res. 2016; 170:264–70.
Article
11. Esteghamati M, Ghasemi K, Nami M. Prevalence of idiopathic hypercalciuria in children with urinary system related symptoms attending a pediatric hospital in Bandar Abbas in 2014. Electron Physician. 2017; 9:5261–64.
Article
12. Penido MG, Diniz JS, Guimarães MM, Cardoso RB, Souto MF, Penido MG. Urinary excretion of calcium, uric acid and citrate in healthy children and adolescents. J Pediatr (Rio J). 2002; 78:153–60.
Article
13. Emamghorashi F, Davami MH, Rohi R. Hypercalciuria in Jahrom's school-age children: what is normal calciumcreatinine ratio? Iran J Kidney Dis. 2010; 4:112–5.
14. Lavocat MP, Freycon MT, Muchrif M. Comparative study of 24-hour calciuria and urinary calcium/creatinine ratio in children over 4 years of age. Pediatrie. 1992; 47:565–8.
15. 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.
Article
16. Alconcher LF, Castro C, Quintana D, Abt N, Moran L, Gonzalez L, et al. Urinary calcium excretion in healthy school children. Pediatr Nephrol. 1997; 11:186–8.
Article
17. Mir S, Serdaroglu E. Quantification of hypercalciuria with the urine calcium osmolality ratio in children. Pediatr Nephrol. 2005; 20:1562–5.
Article
18. Koyun M, Güven AG, Filiz S, Akman S, Akbas H, Baysal YE, et al. Screening for hypercalciuria in schoolchildren: what should be the criteria for diagnosis? Pediatr Nephrol. 2007; 22:1297–301.
Article
19. Carrasco R, Lovell DJ, Giannini EH, Henderson CJ, Huang B, Kramer S, et al. Biochemical markers of bone turnover associated with calcium supplementation in children with juvenile rheumatoid arthritis: results of a double-blind, placebo-controlled intervention trial. Arthritis Rheum. 2008; 58:3932–40.
Article
20. Gül A, Özer S, Yılmaz R, Sönmezgöz E, Kasap T, Takçı Ş, et al. Prevalence of hypercalciuria and urinary calcium excretion in school-aged children in the province of Tokat. Turk Pediatri Ars. 2016; 51:193–7.
Article
21. Touitou Y, Auzéby A, Camus F, Djeridane Y. Twenty-fourhour profiles of urinary excretion of calcium, magnesium, phosphorus, urea, and creatinine in healthy prepubertal boys. Clin Biochem. 2010; 43:102–5.
Article
22. Hilgenfeld MS, Simon S, Blowey D, Richmond W, Alon US. Lack of seasonal variations in urinary calcium/creatinine ratio in school-age children. Pediatr Nephrol. 2004; 19:1153–5.
Article
23. Safarinejad MR. Urinary mineral excretion in healthy Iranian children. Pediatr Nephrol. 2003; 18:140–4.
Article
24. Nuzzo V, Fittipaldi MR, Fonderico F, Esposito Del Puente A, Russo D, Del Puente A, et al. Urinary calcium excretion in a population of children living in Southern Italy. Minerva Pediatr. 1999; 51:53–6.
25. Selimoğlu MA, Alp H, Bitlisli H, Orbak Z, Energin M, Karakelleoğlu C, et al. Urinary calcium excretion of children living in the east region of Turkey. Turk J Pediatr. 1998; 40:399–404.
26. Wong GW, Lam CW, Kwok MY, Mak TW. Urinary calcium excretion in Chinese adolescents. J Paediatr Child Health. 1998; 34:226–8.
27. Esbjörner E, Jones IL. Urinary calcium excretion in Swedish children. Acta Paediatr. 1995; 84:156–9.
28. Sweid HA, Bagga A, Vaswani M, Vasudev V, Ahuja RK, Srivastava RN. Urinary excretion of minerals, oxalate, and uric acid in north Indian children. Pediatr Nephrol. 1997; 11:189–92.
Article
29. Rath B, Aggarwal MK, Mishra TK, Talukdar B, Murthy NS, Kabi BC. Urinary calcium creatinine ratio and hypercalciuria. Indian Pediatr. 1994; 31:311–6.
30. Khadgawat R, Marwaha RK, Garg MK, Ramot R, Oberoi AK, Sreenivas V, et al. Impact of vitamin D fortified milk supplementation on vitamin D status of healthy school children aged 10-14 years. Osteoporos Int. 2013; 24:2335–43.
Article
31. Marwaha RK, Garg MK, Sethuraman G, Gupta N, Mithal A, Dang N, et al. Impact of three different daily doses of vitamin D3 supplementation in healthy school children and adolescents from North India: A single- blind prospective randomized clinical trial. Br J Nutr. 2019; 121:538–548.
Article
32. Sacheck JM, Van Rompay MI, Chomitz VR, Economos CD, Eliasziw M, Goodman E, et al. Impact of Three Doses of Vitamin D3 on Serum 25(OH)D Deficiency and Insufficiency in At-Risk Schoolchildren. J Clin Endocrinol Metab. 2017; 102:4496–4505.
Article
33. Al-Shaar L, Mneimneh R, Maalouf J, Fuleihan Gel-H. Vitamin D3 dose requirement to raise 25-hydroxyvitamin D to desirable levels in adolescents: results from a randomized controlled trial. J Bone Miner Res. 2014; 29:944–51.
34. Narasinga Rao BS, Sivakumar B. Nutritional requirements and recommended daily allowances for Indians. A report of expert group of Indian Council of Medical Research. 2nd ed. New Delhi (India): National Institute of Nutrition;2010.
35. Indian Academy of Pediatrics Growth Charts Committee, Khadilkar V, Yadav S, Agrawal KK, Tamboli S, Banerjee M, et al. Revised IAP growth charts for height, weight and body mass index for 5- to 18-year-old Indian children. Indian Pediatr. 2015; 52:47–55.
Article
36. Sorkhi H, Haji Aahmadi M. Urinary calcium to creatinin ratio in children. Indian J Pediatr. 2005; 72:1055–6.
Article
37. Balk EM, Adam GP, Langberg VN, Earley A, Clark P, Ebeling PR, et al. Global dietary calcium intake among adults: a systematic review. Osteoporos Int. 2017; 28:3315–24.
Article
38. Wahl DA, Cooper C, Ebeling PR, Eggersdorfer M, Hilger J, Hoffmann K, et al. A global representation of vitamin D status in healthy populations. Arch Osteoporos. 2012; 7:155–72.
Article
39. Pal M, Datta S, Pradhan AK, Ghosh T, Ganguly A, Basu S, et al. Determination of upper reference value of urinary calcium-creatinine ratio for the pediatric population in Burdwan district. Adv Biol Chem. 2013; 3:455–9.
40. Ekbote VH, Khadilkar AV, Khadilkar VV, Chiplonkar SA, Mughal Z. Dietary patterns with special reference to calcium intake in 2-16-year-old Urban Western Indian children. Indian J Public Health. 2017; 61:188–93.
Article
Full Text Links
  • APEM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr