Determination of Urinary Calcium and Citrate Ratios in Children with Urolithiasis
Objective: The urine calcium-creatinine ratio (UCa/Cr) varies significantly with age; therefore, age-specific reference ranges are required for accurate interpretation. Using different markers in differential diagnosis may improve diagnostic accuracy. Therefore, we compared the spot urinary calcium-citrate ratio (UCa/Cit) in children with urolithiasis and in a healthy control group. We examined the relationship between the UCa/Cit ratio with age and gender and evaluated its discriminatory performance in differentiating children with urolithiasis from healthy controls.
Methods: This case-control study included 121 children aged 1-18 years with urolithiasis and 107 healthy controls. UCa/Cr and UCa/Cit ratios were calculated in the spot urine sample. Differences between groups were compared, age-related trends were evaluated, and receiver operating characteristic (ROC) analyses were performed to determine diagnostic performance.
Results: The UCa/Cit ratio did not show a statistically significant association with age or gender in this cohort. However, the UCa/Cit level was higher in the patient group compared to the control group (1.28±2.87 vs. 0.63±1.51 mg/mg; P<0.0001). In the ROC analysis, a value of 0.390 mg/mg was determined as the optimal cutoff point for UCa/Cit to distinguish children with urolithiasis from healthy controls (sensitivity, 66.3%; specificity, 65.2%; AUC, 0.675).
Conclusion: Although UCa/Cit was significantly elevated in children with urolithiasis and was not statistically associated with age or gender in this cohort, it had limited discriminatory performance. Therefore, UCa/Cit should be considered a supportive metabolic parameter rather than a standalone diagnostic or screening test. Additional studies with standardized sampling, dietary assessment, and multicenter validation will be required to define its clinical utility in pediatric stone disease.
1. Hu J, Zhang J, Wang J, et al. Global, Regional, and National Epidemiology of Pediatric Urolithiasis (1990-2021) and 2040 Forecast. J Urol. 2025;214(4):435-445. doi: 10.1097/JU.0000000000004645.
2. Rizvi SA, Naqvi SA, Hussain Z, et al. Pediatric urolithiasis: developing nation perspectives. J Urol. 2002;168(4 Pt 1):1522-1525. doi: 10.1016/S0022-5347(05)64509-0.
3. Kroovand RL. Pediatric urolithiasis. Urol Clin North Am. 1997;24(1):173-184. doi: 10.1016/s0094-0143(05)70362-1.
4. Oner A, Demircin G, Ipekçioğlu H, Bülbül M, Ecin N. Etiological and clinical patterns of urolithiasis in Turkish children. Eur Urol. 1997;31(4):453-458. doi: 10.1159/000474506.
5. Ece A, Ozdemir E, Gürkan F, Dokucu AI, Akdeniz O. Characteristics of pediatric urolithiasis in south-east Anatolia. Int J Urol. 2000;7(9):330-334. doi: 10.1046/j.1442-2042.2000.00207.x.
6. Ozokutan BH, Küçükaydin M, Gündüz Z, Kabaklioğlu M, Okur H, Turan C. Urolithiasis in childhood. Pediatr Surg Int. 2000;16(1-2):60-63. doi: 10.1007/s003830050016.
7. Bak M, Ural R, Agin H, Serdaroglu E, Calkavur S. The metabolic etiology of urolithiasis in Turkish children. Int Urol Nephrol. 2009;41(3):453-460. doi: 10.1007/s11255-008-9513-x.
8. Tozsin A, Akdere H, Guven S, Ahmed K. A systematic review on urolithiasis in children with neurological disorders. World J Urol. 2024;42(1):635. doi: 10.1007/s00345-024-05330-5.
9. Castellani D, Giulioni C, De Stefano V, et al. Dietary management of hypocitraturia in children with urolithiasis: results from a systematic review. World J Urol. 2023;41(5):1243-1250. doi: 10.1007/s00345-023-04282-6.
10. Stapleton FB. Childhood stones. Endocrinol Metab Clin North Am. 2002;31(4):1001-1015, ix. doi: 10.1016/s0889-8529(02)00036-1.
11. Mir S, Serdaroglu E. Quantification of hypercalciuria with the urine calcium osmolality ratio in children. Pediatr Nephrol. 2005;20(11):1562-1565. doi: 10.1007/s00467-005-1992-8.
12. Ceran O, Akin M, Aktürk Z, Ozkozaci T. Normal urinary calcium/creatinine ratios in Turkish children. Indian Pediatr. 2003;40(9):884-887.
13. Srivastava T, Winston MJ, Auron A, Alon US. Urine calcium/citrate ratio in children with hypercalciuric stones. Pediatr Res. 2009;66(1):85-90. doi: 10.1203/PDR.0b013e3181a2939e.
14. Menon M, Mahle CJ. Urinary citrate excretion in patients with renal calculi. J Urol. 1983;129(6):1158-1160. doi: 10.1016/s0022-5347(17)52618-x.
15. Subrata HN, Warli SM. Urinary biomarker as a predictor of urolithiasis in children: a systematic review and meta-analysis. Arch Ital Urol Androl. 2025;97(3):14195. doi: 10.4081/aiua.2025.14195.
16. Sirin A, Emre S, Alpay H, Nayir A, Bilge I, Tanman F. Etiology of chronic renal failure in Turkish children. Pediatr Nephrol. 1995;9(5):549-52. doi: 10.1007/BF00860926.
17. Pak CY, Oata M, Lawrence EC, Snyder W. The hypercalciurias. Causes, parathyroid functions, and diagnostic criteria. J Clin Invest. 1974;54(2):387-400. doi: 10.1172/JCI107774.
18. Çalışkan S, Erkan T, Sever L, Arısoy N. İstanbul da Çocuklarda Hiperkalsiüri Taraması [Hypercalciuria in School Children in Istanbul]. Türk Pediatri Arşivi. 1992;27(1):36-38. doi: 10.4274/TPA.V27I1.5000002870. [Article in Turkish]
19. Alon US. Medical treatment of pediatric urolithiasis. Pediatr Nephrol. 2009;24(11):2129-2135. doi: 10.1007/s00467-007-0740-7.
20. Esbjörner E, Jones IL. Urinary calcium excretion in Swedish children. Acta Paediatr. 1995;84(2):156-159. doi: 10.1111/j.1651-2227.1995.tb13600.x.
21. Sargent JD, Stukel TA, Kresel J, Klein RZ. Normal values for random urinary calcium to creatinine ratios in infancy. J Pediatr. 1993;123(3):393-397. doi: 10.1016/s0022-3476(05)81738-x.
22. Sakhaee K, Harvey JA, Padalino PK, Whitson P, Pak CY; New Collective Author. The potential role of salt abuse on the risk for kidney stone formation. J Urol. 1993;150(2 Pt 1):310-312. doi: 10.1016/s0022-5347(17)35468-x.
23. Osorio AV, Alon US. The relationship between urinary calcium, sodium, and potassium excretion and the role of potassium in treating idiopathic hypercalciuria. Pediatrics. 1997;100(4):675-681. doi: 10.1542/peds.100.4.675.
24. Ferraro PM, Taylor EN, Curhan GC. 24-Hour Urinary Chemistries and Kidney Stone Risk. Am J Kidney Dis. 2024;84(2):164-169. doi: 10.1053/j.ajkd.2024.02.010.
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- Article Type Research Article
- Submitted March 13, 2026
- Accepted June 3, 2026
- Published June 14, 2026
- Issue 2026: Online First
- Section Research Article
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