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Vitamin D deficiency is prevalent among idiopathic stone formers, but does correction pose any risk?
Urolithiasis 2017; 45(6):535-543U

Abstract

While vitamin D (vitD) deficiency is thought to contribute to poor health in a variety of ways and should be corrected, there is still concern about giving vitD supplements to patients with a history of nephrolithiasis. The aim is to study the prevalence of vitD deficiency and the effect on stone risk of cholecalciferol (vitD3) supplementation in a cohort of idiopathic stone formers (ISF). We screened for vitD deficiency and urinary measures of stone risk, comparing vitD deficient (serum 25-OH vitD ≤30 nmol/L; ≤12 ng/mL) with vitD insufficient (31-75 nmol/L; 13-30 ng/mL) or vitD replete (>75 nmol/L; >30 ng/mL); we investigated the effect of giving vitD3 (20,000 IU orally, weekly for 4 months) to 37 of the vitD deficients. Thirty-one percent (142/456) were vitD deficient, 57% (259/456) vitD insufficient, and the rest (12%) vitD replete (55/456). Comparison among the groups showed that baseline 24-h urinary measures related to stone risk expressed as concentration ratios over urine creatinine (Cr), such as U. Calcium/Cr, U. Oxalate/Cr, U. Citrate/Cr, and U. Uric acid/Cr were not significantly different. VitD3 supplementation did significantly increase serum 25-OH vitD levels and U. Phosphate/Cr ratios, as well as reduce serum parathyroid hormone (PTH) concentrations. Following vitD3 supplementation, there was an overall rise in 24-h urine calcium excretion, but it failed to reach statistical significance (p = 0.06). U. Calcium/Cr increased in 22 out of 37 patients (average increase +0.07 mmol/mmol), decreased in 14 (average decrease -0.13 mmol/mmol), and remained unchanged in 1; 6 out of 26 initially normocalciuric ISF developed hypercalciuria; and 6 out of 9 patients who became vitD replete were hypercalciuric after supplementation. It is appropriate to monitor urinary Ca excretion in vitD-supplemented stone formers, because it may reveal underlying hypercalciuria in some treated patients.

Authors+Show Affiliations

UCL Centre for Nephrology, Department of Clinical Biochemistry, Royal Free Campus and Hospital, Rowland Hill Street, London, NW3 2PF, UK.UCL Centre for Nephrology, Department of Clinical Biochemistry, Royal Free Campus and Hospital, Rowland Hill Street, London, NW3 2PF, UK.UCL Centre for Nephrology, Department of Clinical Biochemistry, Royal Free Campus and Hospital, Rowland Hill Street, London, NW3 2PF, UK. Division of Nephrology, Department of Medical Sciences, Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy.UCL Centre for Nephrology, Department of Clinical Biochemistry, Royal Free Campus and Hospital, Rowland Hill Street, London, NW3 2PF, UK. lshavit@szmc.org.il. Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel. lshavit@szmc.org.il.UCL Centre for Nephrology, Department of Clinical Biochemistry, Royal Free Campus and Hospital, Rowland Hill Street, London, NW3 2PF, UK.UCL Centre for Nephrology, Department of Clinical Biochemistry, Royal Free Campus and Hospital, Rowland Hill Street, London, NW3 2PF, UK. Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.Division of Nephrology, Department of Medical Sciences, Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy.UCL Centre for Nephrology, Department of Clinical Biochemistry, Royal Free Campus and Hospital, Rowland Hill Street, London, NW3 2PF, UK.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27981376

Citation

Johri, Nikhil, et al. "Vitamin D Deficiency Is Prevalent Among Idiopathic Stone Formers, but Does Correction Pose Any Risk?" Urolithiasis, vol. 45, no. 6, 2017, pp. 535-543.
Johri N, Jaeger P, Ferraro PM, et al. Vitamin D deficiency is prevalent among idiopathic stone formers, but does correction pose any risk? Urolithiasis. 2017;45(6):535-543.
Johri, N., Jaeger, P., Ferraro, P. M., Shavit, L., Nair, D., Robertson, W. G., ... Unwin, R. J. (2017). Vitamin D deficiency is prevalent among idiopathic stone formers, but does correction pose any risk? Urolithiasis, 45(6), pp. 535-543. doi:10.1007/s00240-016-0954-x.
Johri N, et al. Vitamin D Deficiency Is Prevalent Among Idiopathic Stone Formers, but Does Correction Pose Any Risk. Urolithiasis. 2017;45(6):535-543. PubMed PMID: 27981376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vitamin D deficiency is prevalent among idiopathic stone formers, but does correction pose any risk? AU - Johri,Nikhil, AU - Jaeger,Philippe, AU - Ferraro,Pietro M, AU - Shavit,Linda, AU - Nair,Devaki, AU - Robertson,William G, AU - Gambaro,Giovanni, AU - Unwin,Robert J, Y1 - 2016/12/16/ PY - 2016/06/29/received PY - 2016/11/04/accepted PY - 2016/12/17/pubmed PY - 2018/6/22/medline PY - 2016/12/17/entrez KW - Calcium KW - Kidney KW - Nephrolithiasis KW - Renal stones KW - Vitamin D SP - 535 EP - 543 JF - Urolithiasis JO - Urolithiasis VL - 45 IS - 6 N2 - While vitamin D (vitD) deficiency is thought to contribute to poor health in a variety of ways and should be corrected, there is still concern about giving vitD supplements to patients with a history of nephrolithiasis. The aim is to study the prevalence of vitD deficiency and the effect on stone risk of cholecalciferol (vitD3) supplementation in a cohort of idiopathic stone formers (ISF). We screened for vitD deficiency and urinary measures of stone risk, comparing vitD deficient (serum 25-OH vitD ≤30 nmol/L; ≤12 ng/mL) with vitD insufficient (31-75 nmol/L; 13-30 ng/mL) or vitD replete (>75 nmol/L; >30 ng/mL); we investigated the effect of giving vitD3 (20,000 IU orally, weekly for 4 months) to 37 of the vitD deficients. Thirty-one percent (142/456) were vitD deficient, 57% (259/456) vitD insufficient, and the rest (12%) vitD replete (55/456). Comparison among the groups showed that baseline 24-h urinary measures related to stone risk expressed as concentration ratios over urine creatinine (Cr), such as U. Calcium/Cr, U. Oxalate/Cr, U. Citrate/Cr, and U. Uric acid/Cr were not significantly different. VitD3 supplementation did significantly increase serum 25-OH vitD levels and U. Phosphate/Cr ratios, as well as reduce serum parathyroid hormone (PTH) concentrations. Following vitD3 supplementation, there was an overall rise in 24-h urine calcium excretion, but it failed to reach statistical significance (p = 0.06). U. Calcium/Cr increased in 22 out of 37 patients (average increase +0.07 mmol/mmol), decreased in 14 (average decrease -0.13 mmol/mmol), and remained unchanged in 1; 6 out of 26 initially normocalciuric ISF developed hypercalciuria; and 6 out of 9 patients who became vitD replete were hypercalciuric after supplementation. It is appropriate to monitor urinary Ca excretion in vitD-supplemented stone formers, because it may reveal underlying hypercalciuria in some treated patients. SN - 2194-7236 UR - https://www.unboundmedicine.com/medline/citation/27981376/Vitamin_D_deficiency_is_prevalent_among_idiopathic_stone_formers_but_does_correction_pose_any_risk L2 - https://dx.doi.org/10.1007/s00240-016-0954-x DB - PRIME DP - Unbound Medicine ER -