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22-08-2022 | Hyperparathyroidism | Original Paper

How useful is an oral calcium load test for diagnosing recurrent calcium stone formers?

Authors: Isabelle N. Tostivint, Vincent Castiglione, Rana Alkouri, Jean Philippe Bertocchio, Rachida Inaoui, Michel Daudon, Marie-Paule Dousseaux, Etienne Cavalier, Laurence Pieroni, Hassan Izzedine

Published in: Urolithiasis | Issue 5/2022

Abstract

Hypercalciuria is the main risk factor for recurrent calcium urolithiasis. The goal of our study is to determinate how useful an oral calcium load test is for stone formers to classify different forms of hypercalciuria in pathogenetic categories defined as renal or absorptive according to the current knowledge. Between June 2013 and February 2016, a prospective study was carried out on 117 documented recurrent hypercalciuric stone formers undergoing an oral calcium load test modified from the original description by Pak. After 2 days of calcium-restricted diet, urine and blood were analyzed at baseline and 120 min after receiving orally 1 g of calcium. Total and ionized calcium, parathyroid hormone from serum and urine calcium and creatinine were assessed in order to divide patients in three groups as previously described: resorptive, absorptive, and renal hypercalciuria. This allowed the identification of 19, 39, 34 and 33 patients with normocalcemic primary hyperparathyroidism (NPHPT), renal hypercalciuria aka renal calcium leak (RCL), absorptive hypercalciuria (AH) and unidentified cause, respectively. Patients with NPHPT (who required parathyroidectomy) experienced a lower PTH decrease (41.41 ± 12.82 vs. 54.06 ± 13.84% p < 0.01), higher beta-crosslaps, as well as lower TmP/GFR and distal third radius bone mineral density. RCL resulted in increased fasting urine calcium-to-creatinine ratio (Uca/Cr), i.e., > 0.37 mmol/mmol), without hyperparathyroidism. AH was diagnosed by the presence of ΔUCa/Cr > 0.60 mmol/mmol between baseline and 120 min without any other anomaly. For all remaining patients, results were inconclusive due to the lack of sufficient increase in serum calcium or because the cause of lithogenesis could not be clearly identified. The oral calcium load test is useful in nearly 80% of patients by identifying the different forms of hypercalciuria causing urolithiasis and by guiding treatment, including parathyroid surgery.

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Title: How useful is an oral calcium load test for diagnosing recurrent calcium stone formers?
Authors: Isabelle N. Tostivint
Vincent Castiglione
Rana Alkouri
Jean Philippe Bertocchio
Rachida Inaoui
Michel Daudon
Marie-Paule Dousseaux
Etienne Cavalier
Laurence Pieroni
Hassan Izzedine
Publication date: 22-08-2022
Publisher: Springer Berlin Heidelberg
Keywords: Hyperparathyroidism
Urolithiasis
Published in: Urolithiasis / Issue 5/2022
Print ISSN: 2194-7228
Electronic ISSN: 2194-7236
DOI: https://doi.org/10.1007/s00240-022-01355-w

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How useful is an oral calcium load test for diagnosing recurrent calcium stone formers?

Abstract

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