Oral calcium supplementation associated with decreased likelihood of nephrolithiasis prior to surgery for hyperparathyroidism

Abstract

Abstract:We aimed to assess the impact of oral calcium supplementation (OCS) on the prevalence of nephrolithiasis among a cohort of patients undergoing surgery for primary hyperparathyroidism (PHPT). There were 339 patients undergoing surgery for PHPT with detailed past medical history data that were analyzed. 73 patients (22%) had a history of nephrolithiasis prior to parathyroid surgery. Nephrolithiasis was more common among men than women (40% vs 15%, P < 0.001), despite the predominance of women (73% of patients) with hyperparathyroidism. 83 patients (25%) used OCS. OCS was associated with a lower prevalence of nephrolithiasis (9.6% vs 25.4% without OCS, P = 0.002). This protective effect included both men and women (rates of nephrolithiasis with and without supplements: men 19% vs 46%, P = 0.027; women 7% vs 17%, P = 0.04). The mechanism for the apparent protective effect of OCS on rates of nephrolithiasis is unclear, and further research is required to elucidate the variable penetrance of nephrolithiasis among PHPT patients.

Nephrolithiasis and Renal Calcifications in Primary Hyperparathyroidism

“…This also applies to patients with PHPT before PTX. In a cohort of patients with PHPT, Cooperberg et al (31) found a significantly lower prevalence of nephrolithiasis in users compared with nonusers of oral calcium supplement (odds ratio, 0.31; 95% CI, 0.12-0.70). A high oral load of oxalate (spinach, rhubarb) should be avoided.…”

“…Although only few data are available, recent studies have not been able to confirm that the disease predominantly affects either bone or the kidney (17,22,31). Bone mineral density at the lumbar spine, femoral neck, and distal forearm has been reported to be similar in PHPT patients with or without renal stones (17), and the prevalence of nephrolithiasis has been reported to be similar in PHPT patients with (20%) or without (30%) a history of bone fracture (31).…”

Occult urolithiasis in asymptomatic primary hyperparathyroidism

“…13–15 The etiology is thought to be multifactorial with some data indicating younger age, male sex and higher BMI are risk factors for nephrolithiasis in PHPT. 16–19 Other studies suggest that nephrolithiasis is associated with higher serum 1,25(OH) 2 D, calcium, PTH, urine hydroxyproline levels, and higher estimated glomerular filtration rate (eGFR). 13,15,20,21 With the change in paradigm calling for screening for occult nephrolithiasis in all PHPT patients without a clinical stone history, information about the prevalence of silent stones and risk factors for them is needed.…”

Renal manifestations of primary hyperparathyroidism

“…[30] Cooperberg et al ., reported a protective effect of oral calcium supplementation on the rate of nephrolithiasis in PHPT men (19% vs. 46%, P = 0.027) and women (7% vs. 17%, P = 0.04) prior to surgery, for hyperparathyroidism. [31] Locker et al ., have reported increase in urinary calcium with increasing oral calcium dosages and correlated it with higher plasma 1,25(OH) 2 D levels. [32] It is prudent to maintain a moderate calcium intake (up to 1000 mg / day), and consider monitoring of urinary calcium and serum calcitriol in selected cases.…”