Year: 2006
Type: conference-abstract
Abstract: INTRODUCTION AND OBJECTIVE: Calcium-based nephrolithiasis is a common, yet not universal, sequel of hyperparathyroidism.The factors which influence stone formation among patients with markedly elevated parathyroid levels are unclear.In particular, the impact of oral calcium supplementation on incidence of nephrolithiasis among these patients remains ill-defined.METHODS: A prospectively-entered database of patients who have undergone endocrine surgery at UCSF since 1995 was reviewed.339 of 1033 patients with a diagnosis of primary hyperparathyroidism had complete, detailed past medical history data available.Rates of nephrolithiasis were compared between those with and without a history of oral calcium supplementation, as well as other potential risk factors for nephrolithiasis, with the chi-squared test.RESULTS: 73 of the 339 patients (22%) had a preoperative history of nephrolithiasis.The mean age among patients with nephrolithiasis was 55.8, vs 57.9 for non-nephrolithiasis patients (p=.23).Rates of nephrolithiasis were more common among men than women (40% vs 15%, p<.001 ), despite the predominance of women (73% of patients) with hyperparathyroidism. 83 patients (25%) used calcium supplements (23% of men, 25% of women, p=.62).Calcium supplementation reduced the incidence of nephrolithiasis from 25% to 10% (p=.002).This protective effect was seen among both men and women (rates of nephrolithiasis with and without supplements: men 19% vs 46%, p=.027; women 7% vs 17%, p=.04).Calcium supplementation did not affect the risk of bone fracture (13% vs 12% risk with or without supplements, p=.86).However, there was a trend toward higher rates of nephrolithiasis among patients with bone fracture (30% vs 20% for those without fracture, p=.14 ).There were also trends among patients with gout in addition to hyperparathyroidism toward higher rates of both nephrolithiasis (31% vs 21% for those without gout, p=.33) and bone fracture (9% vs 4%, p=.13).Other factors, such as smoking, ethnicity, and parathyroid pathology, did not impact rates of nephrolithiasis.CONCLUSIONS: Among patients with surgically-managed hyperparathyroidism, rates of nephrolithiasis prior to surgery are significantly higher among men than women, despite the markedly higher incidence of hyperparathyroidism among women.Rates of nephrolithiasis among these patients were reduced by 60% among both men and women taking oral calcium supplements.The mechanism for this protective effect is unclear.
Source: The Journal of Urology
Authors: David Kang, George E. Haleblian, Roger L. Sur, Nicholas J. Fitzsimons, Kristy M. Borawski, Glenn M. Preminger
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4246895626