|Values are valid only on day of printing.|
Urinary citrate is a major inhibitor of kidney stone formation due in part to binding of calcium in urine. Low urine citrate levels are considered a risk for kidney stone formation. Several metabolic disorders are associated with low urine citrate. Any condition which lowers renal tubular pH or intracellular pH may decrease citrate (eg, metabolic acidosis, increased acid ingestion, hypokalemia, or hypomagnesemia).
Low urinary citrate is subject to therapy by correcting acidosis, hypokalemia, or hypomagnesemia by altering diet or using drugs such as citrate and potassium.
Diagnosing risk factors for patients with calcium kidney stones.
Monitoring results of therapy in patients with calcium stones or renal tubular acidosis.
A timed 24-hour urine collection is the preferred specimen for measuring and interpreting this urinary analyte. Random collections normalized to urinary creatinine may be of some clinical use in patients who cannot collect a 24-hour specimen, typically small children. Therefore, this random test is offered for children <16 years old.
A low value represents a potential risk for kidney stone formation/growth. Patients with low urinary citrate, and new or growing stone formation may benefit from adjustments in therapy known to increase urinary citrate excretion.
Very low levels suggest investigation for the possible diagnosis of metabolic acidosis (eg, renal tubular acidosis).
For children ages 5 to 18, a ratio of <0.176 mg citrate/ mg creatinine is below the 5% reference range and considered low.(1)
Drugs that lower systemic pH, potassium, and/or magnesium lower urine citrate and are to be avoided in patients with tendency to calcium stones. Conversely, drugs that raise systemic pH, potassium, and/or magnesium may raise urine citrate and should be considered in treating patients or interpreting results.
No established reference values
1. Srivastava T, Winston MJ, Auron A et al: Urine calcium/citrate ratio in children with hypercalciuric stones. Pediatr Res 2009;66:85-90
2. Hosking DH, Wilson JW, Liedtke RR, et al: The urinary excretion of citrate in normal persons and patients with idiopathic calcium urolithiasis (abstract). Urol Res 1984;12:26