Determination of Reference Interval (RI) of Spot Urinary Oxalate to Creatinine Ratio in Children of Pakistani Origin Under Six Years of Age: A Cross-sectional Study

Overview

Journal Ann Med Surg (Lond)

Publisher Wolters Kluwer

Specialty Medical Education

Date 2021 Apr 26

PMID 33898026

Citations 1

Authors

Syed Bilal Hashmi

Lena Jafri

Jamsheer Talati

Hafsa Majid

Saqib Qazi

Aysha Habib Khan

Affiliations

Soon will be listed here.

Abstract

Background: The gold standard screening method of hyperoxaluria in children is using 24-hour urine collection. Urine collection may be cumbersome and challenging for children. Reference intervals (RI) of oxalate for the Pakistani population are not readily available. Therefore we aimed to determine the oxalate to creatinine ratio (Ox: Cr) for Pakistani children <6 years of age.

Materials And Methods: A cross-sectional study was conducted at Aga Khan University from June 2018 to October 2019. Random urine samples from apparently healthy children < 6 years were collected and stored at -30°C until analysis after adding 6M HCl. Oxalate was measured on Micro lab 300 using a kit based on oxalate oxidase principle, while creatinine was measured by kinetic Jaffe reaction. Data was analyzed by EP evaluator and SPSS 23. Ox: Cr ratio was calculated and reported with 90% confidence interval (CI) and interquartile range (IQR).

Results: The mean age of study subjects (n=120) was 29 ±22.3 months with an M: F ratio of 1:1. Children of various ethnicities were included from all over Karachi. The majority of the subjects were Urdu speaking (37.5%). Median Ox: Cr was 0.13(0.10). No significant difference was noted in the median Ox: Cr ratio between various ethnicities (p>0.05). It was significantly different in group I to V which was 0.25 (IQR: 0.06), 0.19 (IQR: 0.11), 0.15 (IQR: 0.04), 0.11 (IQR: 0.06) and 0.08 (IQR: 0.04) respectively (pvalue <0.001).

Conclusion: The established RIs of Ox: Cr ratio was 0.05-0.34 (90% CI). Ox: Cr ratio showed a declining trend with age. Large scale reference interval studies are encouraged, taking diet and age into consideration.

Citing Articles

Reference Intervals for Blood Chemistry Parameters in the Pakistani Population: A Systematic Review of Published Literature.

Afzal N, Ahmed S EJIFCC. 2024; 35(2):71-82.

PMID: 39247659 PMC: 11380145.

References

Dursun I, Celik I, Poyrazoglu H, Kose K, Tanrikulu E, Sahin H . Urinary oxalate to creatinine ratios in healthy Turkish schoolchildren. Ren Fail. 2016; 39(1):146-152. PMC: 6014300. DOI: 10.1080/0886022X.2016.1256308. View

Nguyen Q, KALIN A, Drouve U, Casez J, Jaeger P . Sensitivity to meat protein intake and hyperoxaluria in idiopathic calcium stone formers. Kidney Int. 2001; 59(6):2273-81. DOI: 10.1046/j.1523-1755.2001.00744.x. View

Holmes R, Goodman H, Hart L, Assimos D . Relationship of protein intake to urinary oxalate and glycolate excretion. Kidney Int. 1993; 44(2):366-72. DOI: 10.1038/ki.1993.253. View

Marangella M, Bianco O, Martini C, Petrarulo M, Vitale C, LINARI F . Effect of animal and vegetable protein intake on oxalate excretion in idiopathic calcium stone disease. Br J Urol. 1989; 63(4):348-51. DOI: 10.1111/j.1464-410x.1989.tb05214.x. View

Molla A, Khurshid M, Manser W, Lalani R, Alam A, Mohammad Z . Suggested reference ranges in clinical chemistry for apparently healthy males and females of Pakistan. J Pak Med Assoc. 1993; 43(6):113-5. View

Talati J, Hulton S, Garrelfs S, Aziz W, Rao S, Memon A . Primary hyperoxaluria in populations of Pakistan origin: results from a literature review and two major registries. Urolithiasis. 2017; 46(2):187-195. DOI: 10.1007/s00240-017-0996-8. View

Cochat P, Rumsby G . Primary hyperoxaluria. N Engl J Med. 2013; 369(7):649-58. DOI: 10.1056/NEJMra1301564. View

Pearle M, Roehrborn C, Pak C . Meta-analysis of randomized trials for medical prevention of calcium oxalate nephrolithiasis. J Endourol. 1999; 13(9):679-85. DOI: 10.1089/end.1999.13.679. View

Knight J, Easter L, Neiberg R, Assimos D, Holmes R . Increased protein intake on controlled oxalate diets does not increase urinary oxalate excretion. Urol Res. 2009; 37(2):63-8. PMC: 2683385. DOI: 10.1007/s00240-009-0170-z. View

10.

Dursun I, Poyrazoglu H, Dusunsel R, Gunduz Z, Gurgoze M, Demirci D . Pediatric urolithiasis: an 8-year experience of single centre. Int Urol Nephrol. 2007; 40(1):3-9. DOI: 10.1007/s11255-007-9234-6. View

11.

Sikora P, Zajaczkowska M, Zinkiewicz Z, Wawrzyszuk T . [Evaluation of oxalate/creatinine ratio in the second morning urine sample of health school children]. Pol Merkur Lekarski. 2001; 10(58):271-3. View

12.

Sweid H, Bagga A, Vaswani M, Vasudev V, Ahuja R, Srivastava R . Urinary excretion of minerals, oxalate, and uric acid in north Indian children. Pediatr Nephrol. 1997; 11(2):189-92. DOI: 10.1007/s004670050257. View

13.

Kaya Gurgoze M, Sari M . Results of medical treatment and metabolic risk factors in children with urolithiasis. Pediatr Nephrol. 2011; 26(6):933-7. DOI: 10.1007/s00467-011-1803-3. View

14.

Matos V, van Melle G, Werner D, Bardy D, Guignard J . Urinary oxalate and urate to creatinine ratios in a healthy pediatric population. Am J Kidney Dis. 1999; 34(2):e1. DOI: 10.1053/AJKD034000e6. View

15.

Poyrazoglu H, Dusunsel R, Yazici C, Durmaz H, Dursun I, Sahin H . Urinary uric acid : creatinine ratios in healthy Turkish children. Pediatr Int. 2009; 51(4):526-9. DOI: 10.1111/j.1442-200X.2008.02785.x. View

16.

Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G . STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery. Int J Surg. 2019; 72:156-165. DOI: 10.1016/j.ijsu.2019.11.002. View

17.

Solberg H . International Federation of Clinical Chemistry. Scientific committee, Clinical Section. Expert Panel on Theory of Reference Values and International Committee for Standardization in Haematology Standing Committee on Reference Values. Approved.... Clin Chim Acta. 1987; 165(1):111-8. DOI: 10.1016/0009-8981(87)90224-5. View

18.

Ravichandran V, Selvam R . Increased lipid peroxidation in kidney of vitamin B-6 deficient rats. Biochem Int. 1990; 21(4):599-605. View