What are the steps in 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

Summary of the simplified approach

The simplified approach is carried out as follows:

  • Complete a medical history

  • Carry out initial blood and 24-hour urine testing

  • Identify hypercalciuric patients

  • Check hypercalcemic patients for hyperparathyroidism with PTH levels; consider a thiazide challenge test if the PTH level alone is inconclusive

  • Check hypophosphatemic patients for hyperphosphaturia and possible absorptive hypercalciuria type III (renal phosphate leak hypercalciuria); verify the diagnosis by determining the vitamin D-3 level or with a clinical trial of orthophosphate therapy

  • Start a therapeutic trial of dietary modification treatment

  • Repeat the blood and 24-hour urine tests

  • If the hypercalciuria is controlled successfully with dietary modification, continue the therapy and repeat testing periodically; if dietary modification is unsuccessful, consider a trial of thiazide therapy

  • Orthophosphates are typically recommended if thiazides are not tolerated well or fail to control urinary calcium levels adequately; they are particularly useful in hypercalciuric patients with elevated Vitamin-D levels; patients whose hypercalciuria fails all of these therapies require further evaluation


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