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Bone involvement in idiopathic hypercalciuria

A.M. Misael da Silva, L.M. dos Reis, R.C. Pereira, E. Futata, C.T. Branco-Martins, I.L. Noronha, B.L. Wajchemberg and V. Jorgetti

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Volume 57 (2002) p. 183 - 191

Abstract

A.M. Misael da Silva, L.M. dos Reis, R.C. Pereira, E. Futata, C.T. Branco-Martins, I.L. Noronha, B.L. Wajchemberg and V. Jorgetti

¹Nephrology Division, ²Immunology Division, and ³Endocrinology Division, University of São Paulo Medical School, São Paulo, Brazil
Background: To evaluate bone involvement in idiopathic hypercalciuria, 40 lithiasic patients and 10 controls were studied. Methods: According to urinary calcium excretion, patients were first classified as hypercalciuric (H_ca, n = 22) and normocalciuric (N_ca,n = 18). The H_ca patients were then subclassified according to bone densitometry (BMD) as osteopenic (H_caO, n = 10) and non-osteopenic(H_caNO,
n = 12). Routine biochemistry, dietary records, bone histomorphometry, and cytokines (IL-1b, IL-6, and TNF) production
by peripheral blood mononuclear cell cultures were studied. Results: There were no differences in routine biochemistry between H_ca and N_ca groups
except for urinary calcium. Inadequate nutrition was observed in H_ca group,showing high protein (80.9% of the patients), carbohydrate (76.2%) and sodium (90%) intake. Calcium intake was low in H_ca (57%) and N_ca (83%) groups. IL-6 and TNF were not different between the H_ca and N_ca groups. IL-1b levels were significantly high in both groups when compared to controls. IL-6 and TNF were higher in H_caO than N_ca. BMD in femoral neck in H_caO was lower than in H_caNO and N_ca groups. Eroded surface (ES/BS) increased in 91% of the H_ca group and 36% had a mineralization defect. In the H_caO group serum PTH
correlated negatively with trabecular bone volume (BV/TV) and positively with ES/BS.
1,25(OH)₂D₃ levels correlated positively with osteoblastic surface.
Calcium intake correlated positively with BV/TV and inversely with ES/BS. A negative
correlation was observed between IL-6 levels and Z score of the femoral neck. Conclusion:Bone involvement was detected in a young population with nephrolithiasis demonstrating that a strict follow-up is necessary in order to control hypercalciuria.

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