What is the simplified workup for hypercalciuria?

Updated: Apr 23, 2019
  • Author: Stephen W Leslie, MD, FACS; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

An alternate approach to the diagnosis of hypercalciuria is based on patients’ clinical responses. This simplified clinical approach is much easier and more practical for the vast majority of physicians and patients.

In this system, initial blood and 24-hour urine testing is performed, but the finding of hypercalciuria does not automatically require further testing, such as a calcium-loading test, to determine the exact etiology of the excess urinary calcium. Instead, a trial of therapy is instituted, usually based on dietary guidelines (after first screening the patient with blood tests for kidney failure, hyperuricemia, hypophosphatemia, and hypercalcemia).

The clinical response is evaluated with repeat 24-hour urine testing. If the hypercalciuria has resolved after dietary changes alone, the treatment plan is judged adequate and can be continued. If the response to dietary measures is insufficient, additional medical treatment is necessary. Blood and 24-hour urine testing is repeated at periodic intervals of 30-90 days. Longer intervals emphasize patient compliance, while shorter periods stress efficacy.

Appropriate treatment modifications are suggested until the results are stable, with acceptable urinary risk-factor levels.

Not only is the simplified clinical method much easier to perform and follow than the traditional workup, it also corresponds to what many experts actually carry out in their own clinical practices. The precise diagnosis may not always be clear, but the patient receives essentially the same treatment without the need for an inconvenient expensive test that is hard to interpret.


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