Defining hypercalciuria in nephrolithiasis

Kidney Int. 2011 Oct;80(7):777-82. doi: 10.1038/ki.2011.227. Epub 2011 Jul 20.

Abstract

The classic definition of hypercalciuria, an upper normal limit of 200 mg/day, is based on a constant diet restricted in calcium, sodium, and animal protein; however, random diet data challenge this. Here our retrospective study determined the validity of the classic definition of hypercalciuria by comparing data from 39 publications analyzing urinary calcium excretion on a constant restricted diet and testing whether hypercalciuria could be defined when extraneous dietary influences were controlled. These papers encompassed 300 non-stone-forming patients, 208 patients with absorptive hypercalciuria type I (presumed due to high intestinal calcium absorption), and 234 stone formers without absorptive hypercalciuria; all evaluated on a constant restricted diet. In non-stone formers, the mean urinary calcium was well below 200 mg/day, and the mean for all patients was 127±46 mg/day with an upper limit of 219 mg/day. In absorptive hypercalciuria type I, the mean urinary calcium significantly exceeded 200 mg/day in all studies with a combined mean of 259±55 mg/day. Receiver operating characteristic curve analysis showed the optimal cutoff point for urinary calcium excretion was 172 mg/day on a restricted diet, a value that approximates the traditional limit of 200 mg/day. Thus, on a restricted diet, a clear demarcation was seen between urinary calcium excretion of kidney stone formers with absorptive hypercalciuria type I and normal individuals. When dietary variables are controlled, the classic definition of hypercalciuria of nephrolithiasis appears valid.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Calcium / urine*
  • Humans
  • Hypercalciuria / complications
  • Hypercalciuria / diagnosis*
  • Hypercalciuria / diet therapy
  • Hypercalciuria / urine
  • Nephrolithiasis / complications
  • Nephrolithiasis / diet therapy
  • Nephrolithiasis / urine*
  • ROC Curve
  • Retrospective Studies

Substances

  • Calcium