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Hypercalciuria: its value as a predictive risk factor for nephrolithiasis in asymptomatic primary hyperparathyroidism?

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Abstract

Context

The latest guidelines of the 4th International Workshop on Asymptomatic Primary Hyperparathyroidism (aPHPT) reintroduced hypercalciuria (i.e. urinary calcium > 400 mg/day) as criterion for surgery. However, the value of hypercalciuria as a predictor of nephrolithiasis and the correct cut-off values still need to be confirmed.

Objective

To evaluate the prevalence of silent kidney stones in a large series of patients with aPHPT and the sensibility, specificity and predictive value of different cut-off values of hypercalciuria in identifying patients with nephrolithiasis.

Design

One hundred seventy-six consecutive patients with aPHPT were evaluated at our Institution by serum and urinary parameters and kidney ultrasound.

Results

Silent nephrolithiasis was found in 38 (21.6%) patients. In the univariate and multivariate model, hypercalciuria was a predictor of nephrolithiasis using the criterion of 400 mg/24 h [(OR 2.30, (1.11–4.82) P = 0.025], 4 mg/kg/bw [OR 2.65, (1.14–6.25) P = 0.023], gender criterion [OR 2.79, (1.15–6.79) P = 0.023] and the cut-off value derived from the ROC analysis [(> 231 mg/24 h) OR 5.02 (1.68–14.97) P = 0.004]. Despite these several predictive criteria, however, hypercalciuria had a low positive predictive value (PPV), ranging from 27.4 to 32.7%.

Conclusions

Hypercalciuria is a predictor of nephrolithiasis, but its PPV is low.

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Acknowledgements

We thank the Italian Society for Osteoporosis, Mineral Metabolism and Skeletal disease (SIOMMMS) for its financial support.

Funding

This paper was partially founded by the “young researcher Grant” from the Italian Society for Osteoporosis, Mineral Metabolism and Skeletal disease (SIOMMMS) (to FS).

Author information

Author notes

  1. Federica Saponaro and Filomena Cetani contributed equally to the study.

Authors and Affiliations

  1. Department of Pathology, University of Pisa, Pisa, Italy

    F. Saponaro

  2. Endocrinology Unit, University of Pisa, Pisa, Italy

    F. Saponaro, F. Cetani, L. Mazoni, M. Apicella, M. Di Giulio, F. Carlucci, E. Pardi, S. Borsari & C. Marcocci

  3. Institute of Clinical Physiology, National Council of Research, Pisa, Italy

    M. Scalese

  4. Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physician and Surgeons, Columbia University, New York, NY, USA

    J. P. Bilezikian

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  1. F. Saponaro
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  2. F. Cetani
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  3. L. Mazoni
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Contributions

FS and FC are directly responsible for patients’ evaluations, data collection, manuscript draft. CM is responsible for the original idea. CM and JPB are responsible for supervision of experiments and draft writing. LM, MA, MDG and FC helped in collecting patients’ data. EP and SB are responsible for laboratory analyses. MS is responsible for statistical analysis.

Corresponding author

Correspondence to F. Saponaro.

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The authors declare that they have no conflict of interest.

Human research

This study has been approved by the appropriate institutional and/or national research ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Saponaro, F., Cetani, F., Mazoni, L. et al. Hypercalciuria: its value as a predictive risk factor for nephrolithiasis in asymptomatic primary hyperparathyroidism?. J Endocrinol Invest 43, 677–682 (2020). https://doi.org/10.1007/s40618-019-01162-y

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