What causes calcium stones in nephrolithiasis?

Updated: Jan 13, 2020
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Calcium stones account for 75% of renal calculi. Recent data suggest that a low-protein, low-salt diet may be preferable to a low-calcium diet in hypercalciuric stone formers for preventing stone recurrences. [7] Epidemiological studies have shown that the incidence of stone disease is inversely related to the magnitude of dietary calcium intake in first-time stone formers.

There is a trend in the urology community not to restrict dietary intake of calcium in recurrent stone formers. This is especially important for postmenopausal women in whom there is an increased concern for the development of osteoporosis. Calcium oxalate, calcium phosphate, and calcium urate are associated with the following disorders:

  • Hyperparathyroidism - Treated surgically or with orthophosphates if the patient is not a surgical candidate

  • Increased gut absorption of calcium - The most common identifiable cause of hypercalciuria, treated with calcium binders or thiazides plus potassium citrate

  • Renal calcium leak - Treated with thiazide diuretics

  • Renal phosphate leak - Treated with oral phosphate supplements

  • Hyperuricosuria - Treated with allopurinol, low purine diet, or alkalinizing agents such as potassium citrate

  • Hyperoxaluria - Treated with dietary oxalate restriction, oxalate binders, vitamin B-6, or orthophosphates

  • Hypocitraturia - Treated with potassium citrate

  • Hypomagnesuria - Treated with magnesium supplements

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