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Spot urine samples to estimate 24-hour urinary calcium excretion in school-age children

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Abstract

Urinary calcium/creatinine ratio (UCa/Cr) on a single spot urine sample is frequently used in children to evaluate calciuria, but its accuracy to estimate 24-h urinary calcium excretion (24hUCa) has not been properly assessed. We analyzed the correlation between UCa/Cr in various spot samples and 24hUCa among healthy children. A 24-h urine specimen and three spot urine samples (evening, first, and second morning) were collected in a convenience sample of children aged 6 to 16 years (n = 101). Measured 24hUCa was compared with UCa/Cr in each of the three spot samples. The ability of UCa/Cr to discriminate between children with and without hypercalciuria (calciuria > 4 mg/kg/24 h, 1 mmol/kg/24 h) and optimal timing of the spot sample were determined. Eighty-five children completed an adequate 24-h urine collection. Pearson correlation coefficients between the UCa/Cr on the spot sample and 24hUCa were 0.64, 0.71, and 0.52 for the evening, first, and second morning spot samples, respectively. Areas under the ROC curve were 0.90, 0.82, and 0.75, respectively, for the corresponding spot samples.

Conclusion: The relatively strong correlation between 24hUCa and UCa/Cr in evening and first morning spot urine samples suggests that these spots could be preferred in clinical practice.

Trial registration: ClinicalTrials.gov, NCT02900261, date of trial registration 14 September 2016.

What is Known:

•Urinary calcium/creatinine ratio on a single spot urine sample is frequently used as a proxy for 24-h urinary calcium excretion.

•Correlation of these indicators, including the best timing for spot urine sampling, has not been properly assessed.

What is New:

•Relatively strong correlations were found between the calcium/creatinine ratio on a single spot urine sample and 24-h urinary calcium excretion in healthy children.

•Evening and first morning spot samples had the highest correlation.

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Abbreviations

UCa/Cr:

Urinary calcium/creatinine ratio

24hUCa:

24-h Urinary calcium excretion

NPV:

Negative predictive value/s

PPV:

Positive predictive value/s

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Acknowledgments

We thank Rosemary Sudan for her help in reviewing the manuscript.

Informed consent

Written consent was obtained from one of the parents (or legal guardian) and the oral consent of the child. In addition, written consent of the child was obtained for those over 14 years.

Funding

This study was supported by Swiss Federal Food Safety and Veterinary Office (FSVO) grant 5.15.03. The funder had no role in the protocol development, data collection, data analysis, or interpretation or publication of the results.

Author information

Author notes

  1. Yan Paccaud, Magali Rios-Leyvraz, Arnaud Chiolero and Paloma Parvex contributed equally to this work.

Authors and Affiliations

  1. Hospital Center of Valais Romand, Hospital of Valais, Avenue Grand-Champsec 80, 0041276034147, 1950, Sion, Switzerland

    Yan Paccaud, René Tabin, Bernard Genin & Michel Russo

  2. Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Yan Paccaud, René Tabin, Bernard Genin, Michel F Rossier & Paloma Parvex

  3. Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland

    Magali Rios-Leyvraz, Murielle Bochud & Pascal Bovet

  4. Central Institute of Hospitals, Hospital of Valais, Sion, Switzerland

    Michel F Rossier

  5. Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland

    Arnaud Chiolero

  6. Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland

    Arnaud Chiolero

  7. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada

    Arnaud Chiolero

Authors
  1. Yan Paccaud
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  2. Magali Rios-Leyvraz
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  3. Murielle Bochud
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  4. René Tabin
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  5. Bernard Genin
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  6. Michel Russo
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  7. Michel F Rossier
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  8. Pascal Bovet
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  9. Arnaud Chiolero
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  10. Paloma Parvex
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Contributions

Mr. Paccaud contributed to design the study, interpreted analyses, and drafted the initial manuscript; Dr. Rios-Leyvraz contributed to design the study, recruited participants, managed data, performed statistical analyses, and critically reviewed the manuscript; Pr Chiolero conceptualized and designed the study, obtained funding, supervised statistical analyses, and critically reviewed the manuscript; Pr Parvex contributed to design the study and to interpret analyses, and critically reviewed the manuscript; Dr. Rossier conducted laboratory analyses and critically reviewed the manuscript; Pr Bochud and Pr Bovet contributed to study design and to interpreted analyses, and critically reviewed the manuscript; Pr Tabin contributed to the study design, recruited participants for the study, and critically reviewed the manuscript; Pr Genin and Dr. Russo recruited participants for the study and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Yan Paccaud.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The study was approved by the ethics research committee of the canton of Vaud (CER-VD, identification number: 2015-01178).

Additional information

Communicated by Gregorio Paolo Milan

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Electronic supplementary material

ESM 1

Scatterplots for calcium excretion in 24-h urine measured and spot urine samples estimated with Ghazali equation. Black continuous line: identity line, i.e., perfect correlation; blue line: linear regression; red lines: calcium excretion > 4 mg/kg/24 h (> 1 mmol/kg/24 h) is considered high (PNG 855 kb)

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Paccaud, Y., Rios-Leyvraz, M., Bochud, M. et al. Spot urine samples to estimate 24-hour urinary calcium excretion in school-age children. Eur J Pediatr 179, 1673–1681 (2020). https://doi.org/10.1007/s00431-020-03662-z

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