Investigating the effect late acidification has on urinary Calcium and Oxalate Recovery.
University of Wales Institute Cardiff
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Urinalysis is a common request in the medical laboratory as it harbours many possible markers for disease. Urine calcium concentration is used to reflect calcium metabolism and is therefore a good tool in monitoring patients with conditions such as, lithiasis, where calcium levels are normally elevated. The measurement of oxalate in urine is used in stone assessment as hyperoxaluria is a high risk factor for stone formation. Complications can arise from the presence of stones therefore diagnosis and management is vital. Monitoring patients can reduce recurrence and thus be cost effective. It is thought that for the accurate measurement of calcium and oxalate pre-analytical acidification of urine required. Acidification prior to urine analysis is thought to re-solubilise calcium and oxalate and prevent calcium from precipitating as salts. Many urine samples are collected into bottles that contain preservative. However some samples arrive at the laboratory unacidified. These samples have acid added to them prior to analysis. This practise can result in a delay in acidification of certain samples. The practise of adding acid by hand and using collection bottles containing acid is questionable; there are health and safety concerns regarding the use of hydrochloric acid. Aim This study investigated the effect late acidification had on urinary calcium and oxalate recovery. It aimed to determine if urine samples would produce similar recovery of the analytes if acid was not added immediately compared to instant acidification. Method 32 volunteers from the laboratory were included in this study. They were asked to provide a random urine sample which was split into six aliquots and labelled 0hr, 2hr, 4hr, 8hr, 24hr and 72hr. Acid was added at the appropriate time and the sample was then analysed for calcium. 8 of the samples were selected for oxalate measurement and were sent to the University Hospital Wales for analysis. Results The findings suggest that no significant difference was found between the various times. Statistical analysis found the P values for both the calcium and oxalate data to be above 0.05 with calcium producing P=1.000 and oxalate P=0.991. Boxplots showed the means to be similar and further statistical data highlighted that all results for both calcium and oxalate were within 2SDs of the mean with the majority being within 1SD. Conclusion The findings of this study suggest that in circumstances where immediate acidification is not possible patient samples would be viable and could be acidified within a three day period without significant deterioration in the recovery of calcium or oxalate.
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