Summary
116 normocalcemic and 8 primary hyperparathyroid (PHPT) patients with calcium (Ca) nephrolithiasis and 10 normal controls underwent 1 g of oral Ca tolerance test following 4 days of Ca restricted diet (400 mg/day). On the basis of urinary Ca/creatinine (Cr) ratio obtained by the test, the 116 patients with normocalcemic nephrolithiasis were divided into 3 groups (normocalciuric nephrolithiasis; NN, absorptive hypercalciuria; AH, renal hypercalciuria; RH) according to our criteria which were slightly modified from Pak et al. Changes in urinary Ca/Cr ratio, and those in serum Ca and phosphorus (P), tubular maximum reabsorption of phosphate/glomerular filtration rate (TmPO4/GFR), nephrogenous adenosine 3′,5′-monophosphate (NcAMP) and plasma immunoreactive parathyroid hormone (iPTH) were determined. As a result, the 116 patients were divided into 82NN, 13AH and 21RH. In general, a rise in serum Ca and fall in NcAMP were seen first, followed by rises in urinary Ca/Cr ratio, serum P and TmPO4/GFR although the changes were small. The group PHPT showed abnormality in the changes of TmPO4/GFR, NcAMP and plasma iPTH. The former one decreased constantly during the test and the latter two did not fall to within the normal range, suggesting parathyroid autonomy or abnormal suppressibility. Regarding the normal controls, all the changes were smallest among the 5 groups and clear parathyroid suppression was not observed while it was seen in the groups NN, AH and RH. In conclusion, oral Ca tolerance test is useful not only to separate NN, AH and RH, but also for the diagnosis of PHPT by demonstrating parathyroid autonomy or abnormal suppressibility assessed by NcAMP and/or TmPO4/GFR.
Similar content being viewed by others
References
Broadus AE, Mahaffey JE, Bartter FC, Neer R (1977) Nephrogenous cyclic adenosine monophosphate as a parathyroid function test. J Clin Invest 60:771–783
Broadus AE, Deftos LJ, Bartter FC (1978) Effects of the intravenous administration of calcium on nephrogenous cyclic AMP: Use as a parathyroid suppression test. J Clin Endocrinol Metab 46:477–487
Broadus AE, Dominguez M, Bartter FC (1978) Pathophysiological studies in idiopathic hypercalciuria: Use of an oral calcium tolerance test to characterize distinctive hypercalciuric subgroups. J Clin Endocrinol Metab 47:751–760
Evans RA, Hills E, Wong SYP, Wyndham LE, Eade Y, Dunstan CR (1984) The pathogenesis of idiopathic hypercalciuria: Evidence for parathyroid hyperfunction. Q J Med 53:41–53
Goldsmith RS, Forland M (1964) Rapid calcium infusion test for hyperparathyroidism. Further experiences. Arch Intern Med 113:550–558
Howard JE, Hopkins TR, Connor TB (1953) On certain physiologic responses to intravenous injection of calcium salts into normal, hyperparathyroid and hypoparathyroid persons. J Clin Endocrinol Metab 13:1–19
Kitamura T, Tanaka M, Abe K, Niijima T (1980) How to differentiate hyperparathyroid patients among intermittent hypercalcemic urinary stone formers: A combined use of immunoreactive parathyroid hormone and nephrogenous adenosine 3′,5′-monophosphate. J Urol 123:328–334
Kitamura T, Hirano Y, Ueda D, Niijima T (1987) Possibility of elevated parathyroid function in patients with calciumcontaining nephrolithiasis as compared with normal controls. Eur Urol 13:90–99
Madvig P, Young G, Marcus R (1984) Assessment of adenosine 3′,5′-monophosphate excretion and an oral calcium tolerance test in the diagnosis of mild primary hyperparathyroidism. J Clin Endocrinol Metab 58:480–487
Pak CYC, Ohata M, Lawrence EC, Snyder W (1974) The hypercalciurias. Causes, parathyroid functions and diagnostic criteria. J Clin Invest 54:387–400
Pak CYC, Kaplan R, Bone H, Townsend J, Waters O (1975) A simple test for the diagnosis of absorptive, resorptive and renal hypercalciurias. N Engl J Med 292:497–500
Sutton RAL, Walker VR (1980) Responses to hydrochlorothiazide and acetazolamide in patients with calcium stones: Evidence suggesting a defect in renal tubular function. N Engl J Med 302:709–713
Walton RJ, Bijvoet OLM (1975) Nomogram for derivation of renal threshold phosphate concentration. Lancet II:309–310
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kitamura, T., Hirano, Y., Ueda, D. et al. Biochemical changes before and during oral calcium tolerance test in calcium stone formers. Urol. Res. 16, 149–155 (1988). https://doi.org/10.1007/BF00256009
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00256009