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Study of Calcium Metabolism in Idiopathic Hypercalciuria by Strontium Oral Load Test

^a Address correspondence to this author at: Divisione Nefrologia, Dialisi e Ipertensione, Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy. Fax 2-26432384; e-mail vezzoli.giuseppe{at}hsr.it.

Calcium excretion and absorption were evaluated in hypercalciuric calcium stone formers by the study of Sr²⁺ excretion and absorption after an oral load. Ca²⁺ stone formers (n = 140) were studied, and the results were compared in the 83 of them who had idiopathic hypercalciuria and in the 57 who had Ca²⁺ excretion within reference values. Hypercalciuric patients showed increased renal Sr²⁺ clearance (CR_E; 5.26 ± 0.358 vs 3.29 ± 0.277 mL/min; P <0.001), whereas Sr²⁺ absorption [assessed as the area under the serum concentration–time curve (AUC)] was increased at 30 and 60 min (1.53 ± 0.087 vs 1.21 ± 0.071 mmol · L^-1 · min; P <0.05), but not at 240 min after the load. In hypercalciuric patients, the AUCs were positively correlated with urinary Sr²⁺ fractional excretion (P <0.001). Conversely, in normocalciuric patients plasma parathyroid hormone (PTH) was negatively correlated with the AUCs (P <0.01) and CR_E (P <0.05), whereas 1,25-dihydroxyvitamin D plasma concentrations normalized to PTH were positively correlated with the AUCs (P <0.05). The results of Sr²⁺ load tests suggest that in the hypercalciuric population, Ca²⁺ absorption is altered predominantly in the duodenum and that the normal regulation exerted by calciotropic hormones on tubular and enteral Ca²⁺ handling is lost.

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