How is hypercalciuria treated in nephrolithiasis?

Updated: Jun 21, 2018
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Hypercalciuria can be subdivided into absorptive, resorptive, and renal-leak categories on the basis of the results of blood tests and 24-hour urinalysis on both regular and calcium-restricted diets. Depending on the specific subtype, the treatment of absorptive hypercalciuria may include modest dietary calcium restriction, thiazide diuretics, oral calcium binders, or phosphate supplementation.

Resorptive hypercalciuria is primary hyperparathyroidism and requires parathyroidectomy, when possible. If parathyroid surgery is not possible, phosphate supplementation is usually recommended. Renal-leak hypercalciuria, which is less common than absorptive hypercalciuria, is usually associated with secondary hyperparathyroidism and is best managed with thiazide diuretics.

Another clinical approach to hypercalciuria, when hyperparathyroidism has been excluded with appropriate blood tests, is avoidance of excessive dietary calcium (usual recommendation, 600-800 mg/d), modest limitation of oxalate intake, and thiazide therapy. If thiazide therapy fails, additional workup (eg, calcium-loading test, more thorough evaluation) may be needed.

Indiscriminate dietary calcium restriction is not advantageous and in fact may increase formation of calculi owing to a secondary increase in oxalate absorption. The reduced dietary calcium reduces the oxalate-binding sites in the gastrointestinal (GI) tract, increasing the free dietary oxalate and leading to increased oxalate absorption. The final product of this is a net increase in stone production.


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