Biochemical characterization of primary hyperparathyroidism with and without kidney stones |
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Authors: | Clarita V Odvina Khashayar Sakhaee Howard J Heller Roy D Peterson John R Poindexter Paulette K Padalino Charles Y C Pak |
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Institution: | (1) Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8885, USA |
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Abstract: | The exact metabolic-physiological background for kidney stone formation in primary hyperparathyroidism (PHPT) is unclear.
To obtain clarification, this retrospective data analysis was conducted in 131 patients with PHPT who had undergone a detailed
ambulatory evaluation on a random diet since 1980. The baseline biochemical presentation of 78 patients with PHPT with stones
was compared with that of 53 patients without stones. Compared to those without stones, the stone-forming patients had a more
marked hypercalciuria (343 ± 148 vs. 273 ± 148 mg/day, P < 0.01). Urinary saturation of calcium oxalate and brushite was significantly higher in stone-formers. Serum PTH and fasting
urinary calcium were similar between the two groups, but serum phosphorus was significantly lower in stone-formers. Serum
calcitriol (available in some patients) showed a slightly higher mean value in stone-formers but the difference was not significant.
The increment in urinary calcium after oral load of 1-g calcium was twofold higher among stone-formers. Radial shaft and L2–L4
bone mineral densities resided within the normal ranges. Stone-formers with PHPT display exaggerated urinary calcium excretion
due to intestinal hyperabsorption of calcium, contributing to a greater enhancement of the saturation of stone-forming calcium
salts. |
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Keywords: | Primary hyperparathyroidism Nephrolithiasis Calcium absorption Hypercalciuria |
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