Editing Stones: Evaluation and Medical Management (section)

==== 24-hour urine collections</span> ====

*Can be used to inform and monitor treatment protocols
*'''<span style="color:#ff0000">Analyzed at minimum for (9): [https://pubmed.ncbi.nlm.nih.gov/24857648/ ★]</span>'''
*#'''<span style="color:#ff0000">Volume</span>'''
*#'''<span style="color:#ff0000">pH</span>'''
*#'''<span style="color:#ff0000">Creatinine</span>'''
*#'''<span style="color:#ff0000">Sodium</span>'''
*#'''<span style="color:#ff0000">Potassium</span>'''
*#'''<span style="color:#ff0000">Calcium</span>'''
*#'''<span style="color:#ff0000">Oxalate</span>'''
*#'''<span style="color:#ff0000">Uric acid</span>'''
*#'''<span style="color:#ff0000">Citrate</span>'''
*#'''In stone formers with known cystine stones or a family history of cystinuria or for those in whom cystinuria is suspected, urinary cystine should additionally be measured.'''
*#Sulfate can be added to assess the volume of protein loading from animal meat

* '''<span style="color:#ff0000">Assess adequacy of 24-hour urine collection, prior to interpretation of results'''
**'''<span style="color:#ff0000">To assess the adequacy of collection, 24-hour urinary creatinine excretion should be considered</span>, taking into account patient gender and body weight (males 20-25mg/kg and females 15-20mg/kg in 24 hours),''' as well as patient recall of the start and end times of his or her collection
***'''Significant aberrations in total creatinine excretion from estimated volumes imply incomplete collection, overcollection, greater than expected muscle mass, or less than expected muscle mass'''
**** For abnormally collected 24 hour urine collections, can divide metabolite excretion by creatinine excretion to compare collections
*'''Markers of protein intake, such as urine urea nitrogen or urinary sulfate, are reflective of animal protein intake and can be used to assess dietary adherence'''.
*Urinary potassium measured at baseline can be compared to urinary potassium obtained during follow-up to gauge compliance with medication regimens.
*'''Primary hyperoxaluria should be suspected when urinary oxalate excretion > 75 mg/day in adults without bowel dysfunction. These patients should be considered for referral for genetic testing and/or specialized urine testing'''
*Fast and calcium load testing should not be performed routinely to distinguish among types of hypercalciuria
*If a patient with calcium urolithiasis uses calcium supplements, 24-hour urine samples should be collected on and off the supplement.
**If urinary supersaturation of the calcium salt in question increases during the period of supplement use, the supplement should be discontinued.