Idiopathic hypercalciuria and formation of calcium renal stones

Fredric L. Coe, Elaine M. Worcester, Andrew Evan

Research output: Contribution to journalReview article

46 Citations (Scopus)

Abstract

The most common presentation of nephrolithiasis is idiopathic calcium stones in patients without systemic disease. Most stones are primarily composed of calcium oxalate and form on a base of interstitial apatite deposits, known as Randall's plaque. By contrast some stones are composed largely of calcium phosphate, as either hydroxyapatite or brushite (calcium monohydrogen phosphate), and are usually accompanied by deposits of calcium phosphate in the Bellini ducts. These deposits result in local tissue damage and might serve as a site of mineral overgrowth. Stone formation is driven by supersaturation of urine with calcium oxalate and brushite. The level of supersaturation is related to fluid intake as well as to the levels of urinary citrate and calcium. Risk of stone formation is increased when urine citrate excretion is <400 mg per day, and treatment with potassium citrate has been used to prevent stones. Urine calcium levels >200 mg per day also increase stone risk and often result in negative calcium balance. Reduced renal calcium reabsorption has a role in idiopathic hypercalciuria. Low sodium diets and thiazide-type diuretics lower urine calcium levels and potentially reduce the risk of stone recurrence and bone disease.

Original languageEnglish (US)
Pages (from-to)519-533
Number of pages15
JournalNature Reviews Nephrology
Volume12
Issue number9
DOIs
StatePublished - Sep 1 2016

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Hypercalciuria
Calcium
Kidney
Calcium Oxalate
Urine
Calcium Citrate
Sodium Chloride Symporter Inhibitors
Sodium-Restricted Diet
Nephrolithiasis
Apatites
Bone Diseases
Durapatite
Citric Acid
Minerals
Recurrence
calcium phosphate
dibasic calcium phosphate dihydrate

ASJC Scopus subject areas

  • Nephrology

Cite this

Idiopathic hypercalciuria and formation of calcium renal stones. / Coe, Fredric L.; Worcester, Elaine M.; Evan, Andrew.

In: Nature Reviews Nephrology, Vol. 12, No. 9, 01.09.2016, p. 519-533.

Research output: Contribution to journalReview article

Coe, Fredric L. ; Worcester, Elaine M. ; Evan, Andrew. / Idiopathic hypercalciuria and formation of calcium renal stones. In: Nature Reviews Nephrology. 2016 ; Vol. 12, No. 9. pp. 519-533.
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