How is hyperoxaluria treated in nephrolithiasis?

Updated: Sep 16, 2021
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Hyperoxaluria may be primary (a rare genetic disease), enteric (due to malabsorption and associated with chronic diarrhea or short-bowel syndrome), or idiopathic. Oxalate restriction and vitamin B-6 supplementation are somewhat helpful in patients with idiopathic hyperoxaluria. Enteric hyperoxaluria is the type that is most amenable to treatment; dietary calcium supplementation often produces dramatic results.

Calcium citrate is the recommended supplement because it tends to further reduce stone formation. Calcium carbonate supplementation is less expensive but lacks citrate’s added benefit. Calcium works as an oxalate binder, reducing oxalate absorption from the GI tract. It should be administered with meals, especially those that contain high-oxalate foods. The supplement should not contain added vitamin D, because this increases calcium absorption, leaving less calcium in the GI tract to bind to oxalate. The optimal 24-hour urine oxalate level is 20 mg/d or less.

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