What is included in long-term monitoring of hypercalciuria?

Updated: Jun 02, 2021
  • Author: Stephen W Leslie, MD, FACS; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Repeat 24-hour urine testing and appropriate blood determinations are needed until the patient’s hypercalciuria is controlled and stable. Once this occurs, repeat testing can be performed less often. Testing once per year is considered reasonable for patients whose stone production and level of hypercalciuria are controlled. If hypercalciuria is not well controlled, appropriate adjustments can be suggested and testing should be repeated more frequently.

As patients modify their diets, they may substitute new foods and beverages for the ones previously restricted. These new dietary items can have an unpredictable effect on the various stone risk factors. Therefore, follow-up 24-hour urine tests should include all of the major stone risk factors and not just calcium.

Routine radiographs, such as an abdominal flat plate (also called KUB [for kidneys, ureters, and bladder]) or plain renal tomograms, are useful for finding any newly formed stones. This is particularly important and helpful in patients whose hypercalciuria is poorly controlled.

Some patients pass additional stones and assume their treatment plan is not working when, actually, these stones had already formed before testing or treatment began. Establishing the number, size, and location of any existing calculi before testing or treatment begins is important. In this way, patients can be reassured that their treatment plan is successfully controlling their hypercalciuria.

Patients with hypercalciuria who have known osteopenia, osteoporosis, or bone demineralization and those with untreated or unresponsive hypercalciuria should have periodic bone density measurements, especially if they are aged 50 years or older.

Pediatric patients

Children with hypercalciuria should be followed at regular intervals by a pediatric nephrologist. Twenty-four–hour urine collections for calcium clearance should be monitored at 6-month intervals. Growth parameters should be followed in all children, and bone mineralization should be measured if less than the DRI of calcium is consumed. Serum electrolytes, uric acid, and lipid panels should be monitored in children on thiazide therapy.

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