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Management of Hypercalciuria and Oxalates in the Prevention of Stone Recurrence

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Urolithiasis

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Abstract

Urinary excretion of calcium and oxalate are two of the critical determinants of urine supersaturation of calcium oxalate salts and the risk of calcium oxalate stone formation. Therefore, treatment to reduce stone recurrence is focused on lowering the excretion of these lithogenic factors. Both diet and medication can lower urine calcium. Thiazide diuretics have been shown to reduce stone recurrence in randomized controlled trials and have the added benefit of improving bone mineral density. Citrate and bisphosphonates can lower urine calcium modestly but have not been well studied in hypercalciuric stone disease. Treatments to lower oxalate are not as well documented as are those for hypercalciuria. For idiopathic hyperoxaluria, pyridoxine and magnesium have been proposed as therapies, but there is conflicting data regarding their effectiveness. In enteric hyperoxaluria, low-oxalate diets and calcium supplements to bind dietary oxalate are the standard therapy. There is great interest in the use of oxalate-degrading bacteria as probiotics to treat hyperoxaluria, but human data is limited at this time.

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Author information

Authors and Affiliations

  1. Department of Medicine, University of Chicago, Litholink Corporation, 2250 W Campbell Park Dr., Chicago, IL, 60612, USA

    John R. Asplin M.D., FASN

  2. Department of Medicine, University of Chicago, Chicago, IL, USA

    John R. Asplin M.D., FASN

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  1. John R. Asplin M.D., FASN
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Correspondence to John R. Asplin M.D., FASN .

Editor information

Editors and Affiliations

  1. Department of Surgery Section of Urology, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan

    Jamsheer J. Talati

  2. Karolinska Institutet, Solnavägen 1, Solna, Stockholm, 171 77, Sweden

    Hans-Goran Tiselius

  3. , Syracuse University, Crouse Hospital, 1226 East Water Street, New York, 13210, New York, USA

    David M. Albala

  4. , Department of Urology, Tongji Hospital, 1095 Jiefang Avenue, Wuhan, 430030, China, People's Republic

    ZHANGQUN YE

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Asplin, J.R. (2012). Management of Hypercalciuria and Oxalates in the Prevention of Stone Recurrence. In: Talati, J., Tiselius, HG., Albala, D., YE, Z. (eds) Urolithiasis. Springer, London. https://doi.org/10.1007/978-1-4471-4387-1_88

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  • DOI: https://doi.org/10.1007/978-1-4471-4387-1_88

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