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[Idiopathic hypercalciuria--recent pathogenetic and diagnostic aspects].

B Hess, U Binswanger

    Schweizerische Medizinische Wochenschrift
    |November 8, 1986
    PubMed
    Summary

    The definition of hypercalciuria is inconsistent, with updated normal urinary calcium levels differing by sex. Current evidence does not strongly link higher 24-hour calciuria to idiopathic calcium stone formers over healthy individuals.

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    [Ultrasound-guided infraclavicular venipuncture at the junction of the axillary and subclavian veins].

    Der Anaesthesist·2014

    Area of Science:

    • Nephrology
    • Metabolic Disorders
    • Urology

    Context:

    • The definition and diagnostic criteria for hypercalciuria remain inconsistently applied in clinical practice.
    • Recent research suggests revised upper normal limits for 24-hour urinary calcium excretion, varying between men and women.
    • Idiopathic calcium stone formation is a common condition with complex metabolic underpinnings.

    Purpose:

    • To critically evaluate the current understanding and diagnostic approaches to hypercalciuria in the context of idiopathic calcium stone disease.
    • To examine the evidence supporting the association between 24-hour calciuria levels and idiopathic calcium stone formation.
    • To assess the validity of current classifications of hypercalciuria based on metabolic evaluations.

    Summary:

    • The term "hypercalciuria" lacks a uniform definition, with updated normal ranges for 24-hour urinary calcium excretion exceeding historical values.
    • There is no conclusive evidence that idiopathic calcium stone formers exhibit higher 24-hour calciuria compared to healthy controls with normal calcium metabolism.
    • Idiopathic calcium stone formers often present with disordered regulation of 1,25-dihydroxy-vitamin D3 production, leading to increased serum levels and enhanced intestinal calcium absorption.
    • Metabolic evaluations are frequently conducted under conditions that do not replicate the physiological state during stone formation.
    • The classification of hypercalciuria into "absorptive" and "renal" types is questionable without identifying the primary metabolic defect.

    Impact:

    • Highlights the need for standardized diagnostic criteria for hypercalciuria to improve patient care and research consistency.
    • Suggests that current diagnostic paradigms for calcium stone disease may need revision based on updated calciuria reference ranges.
    • Emphasizes the importance of understanding underlying metabolic abnormalities, particularly vitamin D regulation and intestinal calcium absorption, in idiopathic calcium stone formers.
    • Underscores the limitations of current hypercalciuria classifications and the necessity for identifying primary metabolic defects before subtyping.
    • Informs clinical decision-making regarding the metabolic workup and management of patients with calcium-based kidney stones.

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