Medical Management of Hypercalciuria

Hypercalciuria is the most commonly identified abnormality in 24-h urine studies of calcium stone formers. Typically no specific etiology is identified and the disorder is termed idiopathic, but secondary causes such as primary hyperparathyroidism, renal tubular acidosis, and states of vitamin D excess must be ruled out on initial evaluation. Timely therapy of hypercalciuria can decrease risk of kidney stone recurrence and may mitigate bone demineralization. In addition to lifestyle changes such as increased fluid intake, dietary changes, and sodium restriction, pharmacological therapy with thiazides and alkali supplementation is often necessary for successful treatment of hypercalciuria. Ongoing monitoring and therapy is necessary to maintain the decrement in risk of stone recurrence.