title: The effect of acidification and oxalate concentration on urine calcium measurements in EQAS materials and patient samples.
abstract: BACKGROUND
  An increase in urine calcium compared to the consensus value was observed in some urine samples of the Dutch External Quality Assessment Scheme (EQAS). It appeared that the increase was due to the addition of oxalate by the EQAS organizers and preanalytical acidification of the samples by some of the participants. Because of this observation, the effect of urine acidification on urine calcium level in EQAS and patient samples with added oxalate was investigated.
  
  
  METHODS
  Twenty-four EQAS urine samples and 20 patient urine samples were subject to recovery measurements of urine calcium before and after addition of sodium oxalate and acidification.
  
  
  RESULTS
  Differences in urine calcium between acidified and non-acidified samples up to 30.9% have been observed in EQAS samples with added oxalate. Patient samples show differences up to 80%. Differences between acidified and non-acidified samples are minimal for low calcium oxalate levels but increase with higher levels. Samples without added oxalate show equal urine calcium results between acidified and non-acidified samples.
  
  
  CONCLUSIONS
  Urine calcium results are decreased in non-acidified samples with an excess of oxalate. In case of hyperoxaluria, acidification of patient urine collections and EQAS samples is recommended for correct urine calcium values.
authors.affiliation: Department of Clinical Chemistry and Haematology, Amphia Hospital, Breda, The Netherlands. avangammeren@amphia.nl
authors.forename: Adriaan J
authors.initials: AJ
authors.lastname: van Gammeren
authors.forename: Corrie
authors.initials: C
authors.lastname: van Haperen
authors.forename: Aldy W H M
authors.initials: AW
authors.lastname: Kuypers
mesh_terms: D000143:Acids / Q000737:chemistry; D002118:Calcium / Q000652:urine*; D002623:Chemistry Techniques, Analytical / Q000592:standards; D003951:Diagnostic Errors; D006801:Humans; D009426:Netherlands; D010070:Oxalates / Q000652:urine*
chemical_list: D000143:Acids; D010070:Oxalates; D002118:Calcium