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What is Calcium/Creatinine ratio? 

Calcium/creatinine ratio is a urine test that is performed to detect excess calcium (hypercalciuria) in the urine. 

The ratio is calculated and expressed for the amount of calcium against creatine released in the urine by the kidneys. It is a screening test used to detect the presence of disorders that lead to excess calcium in the urine. The test is also known as spot urinary calcium/creatinine ratio. 

Abnormally high levels of calcium in urine arise from increased absorption of calcium in intestines, leakage of calcium and phosphorus from kidneys and increased resorption of calcium from bones under the effect of parathyroid hormone. Calcium is excreted in excess amounts in different disease conditions of the parathyroid gland (parathyroidism), kidney stones, multiple myeloma and Paget’s disease, among others. Certain drugs increase the excretion of calcium in urine, such as antacids containing calcium, diuretics, steroids, hormonal treatments (androgens, growth hormone) and overdose of vitamin D

Excessive calcium released from the kidneys also results in hematuria - blood in urine. Calcium/creatinine ratio helps in the diagnosis of kidney stones and other diseases that result in blood in urine, especially in children.

Furthermore, the ratio is used in the diagnosis of a rare genetic condition called familial hypocalciuric hypercalcaemia, which is marked by raised calcium levels in blood and low urine calcium. In such cases, the calcium/creatinine ratio is below the normal value.

  1. Why is a Calcium/Creatinine ratio performed?
  2. How do you prepare for a Calcium/Creatinine ratio?
  3. How is a Calcium/Creatinine ratio performed?
  4. Calcium/Creatinine ratio results and normal range

Doctors order calcium/creatinine ratio to patients who represent with the following:

  • Easy fractures due to diseases related to bone such as multiple myeloma, Paget’s disease and gout
  • Kidney stones
  • Severe pain in abdomen due to gastrointestinal diseases such as peptic ulcer and pancreatitis 
  • Anxiety, confusion and irritability in diseases related to the nervous system
  • Deposition of calcium in blood vessels of the heart such as in myocardial calcification and left ventricular hypertrophy 
  • Familial hypocalciuric hypercalcemia
  • Weakness and psychological depression which are frequently associated with high calcium in urine

The test is also used to monitor calcium in urine after vitamin D supplementation.

Calcium/creatinine ratio is advised to children presenting with the following symptoms:

Calcium level and calcium/creatinine ratio are tested in a random sample of urine. You do not require any special preparation for this test. Fasting is not necessary for calcium/creatinine ratio. Before the test, you must inform your doctor if you are on any medications.

(Health checkup app)

Calcium/creatinine ratio is calculated using calcium and creatinine levels in a random urine sample. The random urine sample is collected in a urine transport tube, which contains a pH stabiliser to maintain the acidity of the sample. The turnaround time or the time period from collection of a urine sample to generation of reports for calcium/creatinine ratio is one day.

Normal results: 

In adults, a urine calcium/creatine ratio of <0.14 is normal and <0.18 is considered to be optimal.

Normal results indicate normal levels of calcium and creatinine in urine and that there is no excess of calcium excreted from kidneys. 

Abnormal results:

In adults, a calcium creatinine ratio of >0.20 indicates an excess of calcium in the urine.

A high value of calcium/creatinine ratio is seen in conditions like:

In some cases, the results obtained from spot or random calcium/creatinine ratio are not correct and do not detect a high level of calcium in urine. Doctors usually suggest a 24-hour urine collection (urine sample that is collected every time you pass urine during 24 hours) in such cases for diagnosing hypercalciuria or increased levels of calcium in the urine.

(Read more: Calcium urine test)

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.


  1. Leslie SW, Gossman WG. Hypercalciuria. [Updated 2019 May 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan
  2. Kevin F. Foley. Urine Calcium: Laboratory Measurement and Clinical Utility. Laboratory Medicine, Volume 41, Issue 11, November 2010, Pages 683–686.
  3. Christensen SE. Familial hypocalciuric hypercalcaemia: a review. Curr Opin Endocrinol Diabetes Obes. 2011 Dec;18(6):359-70
  4. Srivastava T, Schwaderer A. Diagnosis and management of hypercalciuria in children. Curr Opin Pediatr. 2009;21(2):214-219
  5. OrthoInfo [internet]. American Academy of Orthopaedic Surgeons. Paget's disease
  6. Taniegra ED. Hyperparathyroidism. Am Fam Physician. 2004;69(2):333-339
  7. Jones AN, Shafer MM, Keuler NS, Crone EM, Hansen KE. Fasting and postprandial spot urine calcium-to-creatinine ratios do not detect hypercalciuria. Osteoporos Int. 2012;23(2):553-562.
  8. Longman C. Disorders of phosphorus, calcium, and vitamin D. In: Holliday MA, Barrat TM, Avner ED, eds. Pediatric Nephrology. 3rd ed. 1994. Baltimore, MD: Williams and Wilkins. Pp: 619-620.

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