Table 3.
MAIN CAUSES OF CALCIUM STONES AND THEIR TREATMENTS
| Disease | Key Abnormalities | SS | Tissue Changes | Treatment | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sca | PTH | Uca | UpH | UCit | Uox | Uur | V | CaOx | CaP | UA | IP | CDP | ||
| Idiopathic CaOx | N | N | ↑ or N | N | ↓ or N | ↑ or N | ↑ or N | ↓ or N | H | N,H | N,H | ↑ ↑ | 0 | Thiazide for IH; potassium citrate for CaOx, perhaps CaP stones.Allopurinol for hyperuricosuria. Na restriction, possible protein or oxalate restriction. Increased fluids. |
| Idiopathic CaP | N | N | ↑ or N | ↑ | ↓or N | N | N | N | H | H | N | N | ↑ ↑ | |
| PHPT | ↑ | ↑ | ↑ | ↑ | N | N | N | N | H | H | L | ↑ ↑ | ↑ ↑ | Parathyroid surgery |
| Sarcoidosis | ↑ | ↓ | ↑ | N | N | N | N | N | H | H | N | ? | ? | Glucocorticoids, possible ketoconazole |
| Lithium use | ↑ | ↑ | ↑ | ↑ | N | N | N | N | H | H | N | ? | ? | Discontinue lithium |
| Oral supplements of calcium or vitamin D | N or ↑ | N | ↑ | N | N | N | N | N | H | H | L | ? | ? | Discontinue supplements |
| Ileostomy | N or ↓ | N | ↓ | ↓ | ↓ | N | N | ↓ | H | L | H | ↑ | ↑ ↑ | Fluids, alkali; supplements to reduce urine oxalate excretion for short bowel and bariatric surgery |
| Short bowel | N or ↓ | N | ↓ | ↓ | ↓ | ↑ | N | ↓ | H | L | H | N | ↑ ↑ | |
| Bariatric surgery | N or ↓ | N | ↓ | N | ↓ | ↑ | N | N | H | N | N | N | ↑ | |
| RTA | N | N | N or ↑ | ↑ | ↓ | N | N | ↑ | N | H | L | N | ↑ ↑ | Alkali, possible thiazides |
Abbreviations: SCa, serum calcium; PTH, parathyroid hormone; Uca, urine calcium excretion; UpH, urine pH; UCit, urine citrate excretion; UOx, urine oxalate excretion; Uur, urine uric acid excretion; V, urine volume; SS, supersaturation; CaOx, calcium oxalate; CaP, calcium phosphate; UA, uric acid; IP, interstitial apatite deposits (interstitial plaque); CDP, collecting duct (inner medullary and terminal ducts of Bellini) plugging with apatite deposits; IH, idiopathic hypercalciuria; PHPT, primary hyperparathyroidism; RTA, renal tubular acidosis; N, not different from normal; H, high; up and down arrows indicate change from normal people. ?, no available data; 0, not present.