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Dr Basu
Dr Basu, Experienced Specialist
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My son (23yo) gets kidney stones often and has recently been

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My son (23yo) gets kidney stones often and has recently been diagnosed with nephrocalcinosis. He was told to stay hydrated (which I understand as I too get kidney stones) to avoid getting more kidney stones. Is the nephrocalicinosis caused by the same thing as kidney stones? His doctor simply said that they are the same thing and staying hydrated should help. I've done some research but, became more confused after reading articles. My younger son (15yo) has now started getting kidney stones as well. Should I be concerned about him getting calcinosis. Can you advise if staying hydrated is the most effective (or only way) course of action for keeping the nephrocalcinosis from getting worse.

Thank you.
Deb

Dr. D.J. :

The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.

Dr. D.J. :

Hi there,


This is Dr. D.J., experienced Internal Medicine Specialist.


I am here to address your concerns and provide great service.

Dr. D.J. :

I understand your concern.

Dr. D.J. :

Nephrocalcinosis is caused by the excessive calcium concentration in the kidneys.

Dr. D.J. :

Hence, this is little different than just kidney stones.

Dr. D.J. :

Excess calcium concentration can be caused by the hereditary factors, hyperparathyroidism ( parathyroid glands located in the neck), sarcoidosis for example.

Dr. D.J. :

So the underlying causes should be looked for.

Dr. D.J. :

For this purpose, a serum PTH level, serum calcium, magnesium, potassium, 25 OH vitamin D levels should be checked.

Dr. D.J. :

A CT scan of the kidneys also are favored.

Dr. D.J. :

The treatment to reduce calcium concentration in the kidneys include:

Dr. D.J. :

1. adequate hydration more than 2 liters fluid daily.

Dr. D.J. :

2. Potassium citrate solution orally which helps to dissolve calcium well.

Dr. D.J. :

3. restriction of animal proteins --meat, fish, poultry for example.

Dr. D.J. :

4. restricted sodium intake less than 100 meq daily.

Dr. D.J. :

5. increased potassium intake through fruits, potassium supplements.

Dr. D.J. :

Your son should be seen by a kidney specialist for further evaluation.

Dr. D.J. :

Best wishes,

Customer:

The doctor told me he did not order parathyroid tests because my son's urine lacked high levels of calcium. He said the urine had high levels of oxylate. I'm confused because I thought if a person had Ca Oxylate stones there would be high levels of calcium. Also, I thought one had to have excess levels of calcium in the urine to even have nephrocalcinosis. The doctor we saw was a nephrologist. My son had a CT scan at ER when he had a stone. The CT scan revealed the nephrocalcinosis. I want to make sure that the diagnosis is correct and that it is true that nothing can be done except hydration and a few dietary changes. The doctor told me there was no underlying conditions causing the nephrocalcinosis but I do not believe all necessary tests were done. It sounds as though we need a second opinion. Thank you for your assistance.

Dr. D.J. :

ok

Dr. D.J. :

i am still reading.

Dr. D.J. :

Excessive oxaluria can be a genetic problem known as autosomal recessive disorder.

Dr. D.J. :

Secondary hyperoxaluria may also be due to the chronic ingestion of excessive amounts of oxalate precursors, such as vitamin C, or of foods rich in oxalic acid such as rhubarb, parsley, cocoa, nuts, or star fruit (carambola).

Customer:

Oxaluria can cause nephrocalcinosis?

Dr. D.J. :

yes it can

Dr. D.J. :

This is also seen with fat malabsorption like in case of cystic fibrosis.

Dr. D.J. :

Pancreatic insufficiency also can cause fat malabsorption.

Dr. D.J. :

But in this case, I believe it is genetically determined.

Customer:

If that is the case then hydration and diet are the answer correct?

Customer:

Do you believe it would be beneficial to seek another opinion or have more tests?

Dr. D.J. :

yes of course.

Dr. D.J. :

I will definitely suggest a nephrologist consultation.

Customer:

He did see a nephrologist.

Dr. D.J. :

Ok --I will suggest another opinion --atleast a genetic consultation

Customer:

I was concerned about lack of certain tests being done but, perhaps since you explained a little about oxyaluria I understand why the tests may not have been done

Dr. D.J. :

Yes I understand.

Customer:

I will seek out a second opinion.

Customer:

Thank you for your time.

Dr. D.J. :

very welcome

Dr. D.J. :

It was my pleasure to help you today.
Best wishes,
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