Diagnosis of oxalates in urine should be or not

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Oxalates in urine are salts of oxalic acid, which enter along with food and are formed in the body as a result of certain biochemical reactions.

Normally, they are released up to 40 mg per day, and an excess of this value already speaks of pathology from the side of the kidneys. After passing the urine test, the laboratory assistant sees the result and, in case of deviation, explains to the patient what oxalates in the urine mean, and for what reasons an imbalance could have occurred.

This deviation requires treatment, which includes medication and dietary changes. Before getting rid of oxalates, you need to undergo additional examinations to exclude or confirm kidney pathology.

What are oxalates

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The amount of oxalic acid released is an important indicator in the diagnosis of urological pathologies. There are 4 types of these substances, depending on the chemical composition: potassium, ammonium, sodium and calcium salts.

The presence of the latter in urine is the main indicator of metabolic failure or the development of a disease. Having found oxalates in urine and knowing that such a condition is not always a deviation, the doctor will give a referral to a nephrologist for further diagnostic measures.

Rate and deviation

Small amounts of oxalate salts in urine are observed in men and women when eating foods rich in oxalic acid: sorrel, pepper, spinach. A moderate increase indicates the need for constant monitoring of the condition, that is, it is important to regularly take urine for analysis.

The norm of oxalates in daily urine in adults is from 0 to 40 mg, the norm in a child under one year old is from 1 to 1,3 mg.

A large amount of oxalate salts in urine in adults may indicate the development of a urological disease.

Deciphering of analyzes is carried out with the determination of the level of erythrocytes, leukocytes, epithelium, protein, pathological microorganisms. The presence of certain atypical inclusions will be a reason to make a preliminary diagnosis.

Doctors note that oxalates often appear with pathologically increased acidity of urine, but at normal pH (from 5 to 7) they are not formed or they slightly increase.

In people with normal kidney function, a deviation can be observed with a periodic change in acidity, which occurs when the excretion of metabolic products is delayed.

The decoding of the urinalysis may contain such marks as “oxalates ++/+++/++++”. The advantages in this case indicate the degree of metabolic disturbance of oxalic acid. One “+” is a slight deviation, but it already indicates a tendency to the appearance of stones in the urinary tract.

Causes and risk factors

The main reasons why there is an increase in the content of oxalates in the urine:

  • A diet that includes a large amount of products with oxalic acid, which leads to a violation of water-salt metabolism. As a result, salts are formed in the kidneys and urine, which becomes a factor in the onset of oxalaturia. In addition, living in areas with low levels of magnesium in food and water increases the risk of bladder stones.
  • Kidney pathology and urolithiasis. Many pathologies at the initial stage are asymptomatic, but a violation of the process of urinary excretion and a moderate increase in oxalates in the patient’s body will already be diagnostic signs. Men may experience urinary problems in the form of frequent and painful urges. In women, the signs are less pronounced and appear already with a significant violation of the functioning of the kidneys.
  • Lack of vitamin B6 and the intake of a large amount of ascorbic acid into the body.
  • Infectious diseases of the genitourinary system and helminthic invasions (most often these are pinworms).
  • Rare causes: an excess of vitamin C, a decrease in enzymatic activity, impaired absorption of salts in the gastrointestinal tract, increased production of bile acids, a deficiency of magnesium and vitamin B, tubular acidosis.
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This disorder is often associated with bowel pathologies. When in the latter there is a violation of the absorption of oxalate, its amount in the urine increases, and the urinary system begins to work hard.

Problems with the gastrointestinal tract arise from an insufficient number of anaerobic bacteria, which are involved in the breakdown of acid.

In children, a small amount of oxalate in the urine will be the norm, unless there are other signs of pathology.

During pregnancy, the level of oxalic acid salts decreases, and its increase is possible, if a woman wishes, to quickly restore the balance of vitamins by eating a large amount of fruits and vegetables. Another cause of oxaluria during gestation will be a reduction in fluid intake in order to eliminate puffiness.

With the simultaneous detection of oxalates and urates in urine, there is a suspicion of chronic renal failure, urolithiasis, leukemia, gout, pyelonephritis.

Oxalates and protein in the urine are a consequence of physical activity before taking the test, as well as a symptom of infectious hepatitis, inflammation of the bone tissue and scarlet fever.

The combination of oxalates and phosphates indicates the predominance of seafood and dairy products in the diet. Possible diseases – mental disorders, diabetes mellitus, hyperparathyroidism, leukemia in children.

Oxalate and leukocytes – this combination is characteristic of inflammatory pathologies such as urethritis and cystitis. In women, it can be vaginitis, which manifests itself as mucous discharge from the vagina.

Symptoms

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Signs of an increase in oxalate salts in the body will correspond to the disease that provoked the failure.

Most often it is cystitis, stones in the bladder, a violation of the microflora of the urethra, inflammatory pathologies of the genitourinary system with general malaise and an increase in body temperature or with the preservation of normal health.

The most common symptoms are:

  • discomfort and pain in the lower abdomen and in the lumbar region,
  • the appearance of mucus in the urine, less often there is a release of blood,
  • general malaise against the background of intoxication of the body,
  • colic,
  • Frequent urination (sometimes painful)

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With a significant increase in salt levels, there is a risk of the formation of a large calculus, which closes the ducts, preventing the normal flow of urine. This also leads to the accumulation of pathogenic microflora on the walls of the urinary tract, and the underlying disease is aggravated by infection.

In this case, the accompanying symptoms will be pain, frequent and painful urination, fever, and weakness.

Diagnostics

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Crystals of calcium oxalate in urine are detected during general and biochemical analysis of urine. With the help of such a diagnosis, the level of leukocytes and erythrocytes is determined, as well as the causative agent of the infection, if any.

The presence of oxalaturia will have a result of “++” or more. Additionally, a blood test is prescribed. According to its results, the presence of an inflammatory process is determined.

An increased content of oxalates in the urine against the background of a high level of leukocytes in the blood will indicate inflammation, and then it is important to conduct an ultrasound examination of the kidneys, because such indicators may indicate their pathology, in particular nephritis.

To determine the level of oxalic acid salts or sediment, you need to pass an analysis according to Nechiporenko. Before collecting urine, external hygiene of the genitals is carried out, then a portion of morning urine (exclusively the first) is immediately collected. The first 10-20 mm of urine must be skipped, the rest is placed in a special container and sent to the laboratory on the day of collection.

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Treatment

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It is possible to carry out the treatment of oxalates, or rather, the cause of their appearance, only after a comprehensive examination by a urologist and other specialists, depending on the symptoms.

  • Oxalaturia due to dehydration is treated by normalizing the drinking regime.
  • The presence of oxalates in urine when consuming a large amount of products with oxalic acid is eliminated by changing the diet.
  • With oxalaturia against the background of kidney disease, etiological and symptomatic treatment of the underlying disease is carried out.

A mandatory measure, regardless of the disease, will be a change in the patient’s diet. Some foods are completely excluded, but eating foods rich in magnesium and B vitamins will be beneficial. The decision to change the diet is made by the attending physician, who will draw up an approximate menu of a therapeutic diet.

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What products should be discarded:

  • eggplant, potatoes,
  • leeks, chili peppers, parsley,
  • parsnips, rhubarb,
  • sorrel, asparagus, soybeans,
  • green pepper, spinach,
  • celery, beans.

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In the case of renal pathologies, the listed products will need to be completely excluded, like other dishes in which a high content of oxalic acid salts.

If the diet includes products containing cocoa, this will further affect the increase in the level of oxalates, therefore, before consuming confectionery products, it is important to carefully read the composition or check with the waiter.

For the treatment of severe oxalaturia, the doctor may prescribe high doses of magnesium, vitamins B1 and B6 for intramuscular administration. With food, these substances can be obtained from pistachios, walnuts, oatmeal, millet, peas, seaweed, barley, cashews, mustard.

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Diet recommendations for high oxalate content:

  • consume 70-100 g of lean meat daily,
  • drinking plenty of fluids to maintain kidney function,
  • introduce cereals in milk and water into the diet,
  • eat fruits with a low content of oxalic acid,
  • gradually reduce the dose of coffee you drink,
  • replace the usual bread with coarse flour products.

As a drug therapy, the attending physician may prescribe:

  • potassium citrate,
  • magnesium and potassium preparations,
  • diuretics and diuretic herbs,
  • vitamins B6 – pyridoxine hydrochloride.

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If oxalate builds up and the urinary tract is blocked, surgical treatment is required. The operation involves the creation of access to the focus of pathology with the subsequent removal of stones.

After surgical intervention, the patient must be prescribed a therapeutic diet and medicines to prevent complications in the form of infection and inflammation.

Prevention

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The main preventive measure is a diet with a minimum content of foods rich in oxalic acid.

The composition of foods in large quantities should include B vitamins and magnesium. In case of oxalaturia, in some cases it is necessary to be examined by a urologist and nephrologist. This applies to people prone to inflammatory diseases of the urinary system: urinary tract, kidney and bladder.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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