What is the role of vitamin D in the treatment of hypercalciuria?

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

As previously mentioned, many cases of absorptive hypercalciuria involve elevated vitamin-D levels. [8] Vitamin D increases small-bowel absorption of calcium and phosphate, enhances renal filtration, decreases parathyroid hormone (PTH) levels, and reduces renal tubular calcium absorption, which ultimately leads to hypercalciuria.

It has been suggested that some patients have an exaggerated response to, affinity for, or sensitivity to normal levels of vitamin D and its metabolites.

Reduction

Activation of vitamin D-3 takes place in the proximal renal convoluted tubule. This activation can be reduced by ketoconazole therapy.

Oral neutral phosphate therapy, limitation of vitamin-D and calcium intake, and reduction of sunlight exposure can also be useful in treating excess vitamin-D levels and hypervitaminosis D (usually caused by chronic ingestion of excessive amounts of vitamin D). Dipyridamole (Persantine) reduces renal phosphate excretion and may also be useful in controlling excessive vitamin-D levels and reducing vitamin D–dependent hypercalciuria.

Vitamin D is stored in fat, which means that in some cases vitamin-D intoxication may persist for weeks after vitamin-D ingestion has ceased. In these cases, glucocorticoids (roughly 100 mg of hydrocortisone per day or the equivalent) usually return calcium levels to normal within a few days.


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