Calcium – Creatinine Ratio (Urine):
Why Calcium – Creatinine Ratio Test?
CLINICAL INFORMATION
Calcium is one of the most abundant minerals present in our body, but when excessive calcium is present in abnormal levels (hypercalcemia), then it leads to calcification (arteries, kidneys, pericardium, pancreas etc) and thus obstructs organ functions leading to complicated health issues. Calcium is the most vital mineral in the body for the normal physiological functioning of nerves, muscles, and heart. Normal physiological levels of calcium are required for heart function, muscle contraction, nerve signalling and blood clotting. Calcium is a fundamental element necessary to form electrical gradients across membranes and is a vital co-factor for many enzymes. Normal levels of calcium when gets altered to high or low levels of calcium can reflect as a sign of bone diseases, thyroid disease, kidney disease or other medical conditions. In the diagnosis of calcium-related disorders, two tests are performed – ionized calcium and total calcium. Ionized calcium accounts for unattached or free forms of unbound calcium in proteins, while total calcium measures the calcium attached to specific proteins. Clinical manifestations of altered calcium levels are reflected by its symptoms. Symptoms of high calcium levels include nausea, vomiting, more frequent urination, increase thirst, constipation, abdominal pain, and loss of appetite. Diseases associated with higher calcium levels are hyperparathyroidism, kidney or adrenal failure, sarcoidosis, Paget’s disease of the bone, excessive use of antacids, and high intake of calcium from vitamin - D supplements or milk. Low levels of calcium show signs of symptoms such as irregular heartbeat, muscle spasm, muscle cramps and tingling in lips, tongue, fingers, feet etc. Diseases associated with lower calcium levels are hypo-parathyroidism, vitamin-D deficiency, magnesium deficiency, inflammation of the pancreas (pancreatitis), kidney diseases, osteoporosis, osteopenia etc and symptoms of hypocalcemia in neonates include jitteriness, poor feeding, seizures, apnea (slow breathing), tachycardia. Certain diseases such as kidney diseases, thyroid diseases, malnutrition, and medications such as lithium, thiazide diuretics, antacids, atenolol (beta blocker), colestipol (bile acid sequestrants), estrogen, digoxin, antibiotics – fluoroquinolones, tetracyclinsetc and few cancer types with high or low levels of calcium may not reflect any clinical manifestation hence can remain asymptomatic. Creatinine is a metabolic end-product formed by catabolism of the muscles' activity. It is formed by muscle metabolism (i.e break-down product of creatine phosphate or also called phosphocreatine and ATP from the muscle and protein metabolism) of our body. This creatinine circulates in the body and is excreted in urine by the kidneys. Creatinine levels can be increased in cases such as pregnancy, intense exercise, high red meat consumption, medications (ACE inhibitors) etc. The higher levels of circulating creatinine indicate certain pathologies including muscle disorders such as muscular dystrophy, reduced kidney function (acute infections), chronic kidney disease, polycystic kidney disease, dialysis, the prognosis for kidney diseases, congestive heart failure, diabetes mellitus, dehydration, hyperthyroidism, shock, autoimmune diseases, nephrotic syndrome, nephritis, glomerulonephritis, heavy metal toxicity, pyelonephritis, blocked urinary tract, heart failure, enlarged prostate, complications of diabetes, blockage of the urinary tract due to kidney stones, decreased blood flow to the kidneys (dehydration, diabetes and congestive heart failure), drug abuse and infections to kidneys such as post-streptococcal glomerulonephritis, kidney damage or kidney failure etc. While low creatinine may be due to muscle loss, severe liver disease, malnutrition etc. This test is suggested in patients with symptoms like fatigue, muscle cramps, trouble sleeping, loss of appetite, lower back pain, changes in urine output and frequencies, high blood pressure, swelling or fluid retention, nausea and vomiting etc. Hence assessment of the kidney can be performed by renal function test that include creatinine test, BUN test, Glomerular filtration rate, urine calcium-creatinine ratio, albumin/creatinine ratio etc. Calcium/Creatinine Ratio is a random urine calcium-creatinine ratio is used to screen for abnormal disorders such as hypercalciuria. Hypercalcemia is a condition that is mostly reflected as hypercalciuria. High concentrations of calcium in urine will eventually result in crystal or calculi formation (Kidney Stones) and might lead to kidney failure. Some of the conditions associated with such abnormalities are immobilization, steroid therapy, Paget’s disease, primary (idiopathic) hypercalciuria, hyperparathyroidism, vitamin D intoxication, multiple myloma, metastasis from prostate cancer, calcium supplements etc. Causes for calcium build-up in the kidneys may be due to increased absorption of calcium from intestines, leakage of calcium and phosphorous from kidneys, higher rate of reabsorption of calcification (decalcification) from bones due to parathyroid activity, vitamin D therapy (hyper-vitaminosis), other pathological conditions such as primary hyper-parathyroidism, sarcoidosis etc. This creatinine clearance is an important physiological function of the kidneys and is released in urine. Serum and urine creatinine levels are tested to assess the kidney or renal functions, hence its determination of creatinine value indicates as a diagnostic tool in many pathological conditions such as kidney diseases, congenital conditions such as in-born-errors of metabolism and conditions like muscular dystrophy. The calcium/Creatinine ratio is also called as spot urinary Calcium/Creatinine ratio. This test result indicates the rate of calcium excretion. High Calcium/Creatinine ratio helps in the diagnosis of kidney stones while low Calcium/Creatinine ratio are found in conditions such as familial hypo-calciuric – hypercalcemia, which shows a marked elevation in blood calcium levels but decreased levels of urine calcium in the body. This Calcium/Creatinine ratio test also aids in other abnormal conditions such as Paget's disease, gout, bone fractures due to multiple myloma, kidney stones, peptic ulcer, pancreatitis, excessive calcium deposition in the brain leading to CNS abnormalities such as confusion, irritability, anxiety, depression etc, familial hypo-calciuric – hyper-calcemia etc. This Calcium/Creatinine ratio test is indicated in patients with clinical manifestations of blood in urine, pain in the abdomen while passing urine, frequent urination, urge to pass urine, kidney stones (passing stones while urination), frequent UTIs, low calcium in bones etc. Other additional tests include a comprehensive metabolic panel, renal function test, albuminuria, BUN test, urine calcium-creatinine ratio, calcium oxalate test, parathyroid hormone assays, cystatin C test, imaging studies, isotope dilution mass spectroscopy (IDMS) etc. Other tests for calcium include bone density scan or dexa scan (type of x-ray scan) etc.
General Instructions:
Sample Requirement: Specimen - Urine Sample. Test Preparation: None.
NOTE - Sample for specimen collections may vary based on the patient’s condition/cases according to the patient’s presenting complaints/signs or symptoms:
SPECIMEN REQUIREMENT (Special or Rare Cases) - As instructed and guided by Physician / Clinician / Pathologist / as per Laboratory’s requirements, according to procedures and protocols.
This Multi-Specialty Clinical Referral Laboratory RT DIAGNOSTICS provides precise and accurate tests with an extensive range of testing services to the medical centres to help in the diagnosis and identification of pathology in the test specimens for infectious diseases and also to evaluate the function of organ systems of the patient. It prevents further complications and helps to stabilize and restore health to near normalcy at the earliest without delay.
