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[Idiopathic hypercalciuria: can the diuretics be avoided?]
Francisco R Spivacow1, Martín Pailler1, Pablo Martínez1
1Instituto de Investigaciones Metabólicas (IDIM), Universidad del Salvador (USAL), Buenos Aires, Argentina.
Insights
Dietary management effectively controls idiopathic hypercalciuria, a condition marked by high urinary calcium. Dividing patients based on diet response helps manage this condition, potentially delaying medication use.
Area of Science:
- Nephrology
- Endocrinology
- Metabolic Bone Disease
Background:
- Idiopathic hypercalciuria (IH) is characterized by excessive urinary calcium excretion.
- IH affects 19% of women with osteoporosis and 50-70% of kidney stone patients.
- Dietary interventions are a cornerstone of IH management.
Purpose of the Study:
- To evaluate the efficacy of a restricted diet in managing idiopathic hypercalciuria.
- To assess the feasibility of classifying IH patients based on dietary response.
- To explore the potential of diet alone to control hypercalciuria.
Main Methods:
- Retrospective analysis of 206 hypercalciuric patients.
- Selection of 122 diet-dependent hypercalciuric patients (105 women, 17 men).
- Implementation of a controlled diet: 800 mg calcium, 1 g protein, <100 mEq sodium daily.
Main Results:
- Calciuria was controlled in all patients within an average of 17 months.
- 13% of patients remained normocalciuric solely through diet after 42 months.
- Dietary management proved effective in controlling urinary calcium levels.
Conclusions:
- Classifying idiopathic hypercalciuria based on dietary response is crucial.
- Dietary management can effectively control hypercalciuria, potentially avoiding or delaying diuretic use.
- A well-managed restricted diet is a fundamental approach for idiopathic hypercalciuria.
Abstract:
Idiopathic hypercalciuria is defined as calcium excretion greater than 220 and 300 mg/day in women and men respectively, or greater than 4 mg/kg body weight. In women with osteoporosis it is observed in 19% of cases, while in kidney stones cases varies between 50 and 70%. We selected 206 hypercalciuric patients from our database, with and without renal lithiasis, to whom a restricted diet had been indicated. We divided them, according to the response, into a dependent diet and an independent diet. We considered 122 patients with diagnosis of hypercalciuria diet dependent (105 women and 17 men), which were followed with dietary control (800 mg of calcium, around 1 g of animal proteins and < 100 mEq sodium a day). The appearance of stones, or the recurrence of stones, was not considered, nor was bone involvement. After an average of 17 months, everyone had their calciuria controlled and there were even 16 (13%) who, after 42 months of follow-up, continued to be normocalciuric only on a diet. We conclude that the division of the hypercalciurias is fundamental, according to their response to a restricted diet, in order to avoid or postpone the use of diuretics and its adverse effects, with an adequate management of the diet.
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