Leave No Stone Unturned: Renal Stones & Primary Hyperparathyroidism


In our AM report today we reviewed renal stones and primary hyperparathyroidism. Conditions that are not uncommon in the general population and ambulatory setting, particularly asymptomatic cases in the latter. Here are some of our take home points from today’s AM report.

Renal Stones Take Home Points:

  1. 1 in 10 Canadians will develop renal stones in their lifetime (Kidney Foundation of Canada).
  2. Calcium-containing stones are the most common type of renal stones.
  3. 24 hour urine collection is key in determining the etiology of renal stones.
    1. First thing you should order with this collection is a urine creatinine so that you can determine if your collection is appropriate/accurate.
  4. Stones greater than 5 mm in size should be considered for urologic referral and possible intervention.

Primary Hyperparathyroidism Take Home Points:

  1. About 8 in 10 patients with primary hyperparathyroidism have a solitary parathyroid adenoma.
  2. Patients unable to undergo parathyroidectomy should have creatinine and calcium checks annually with BMD testing every 1-2 years for surveillance.
  3. Patients with asymptomatic hyperparathyroidism should be referred for surgery if:
    1. History of renal stones, potential of loss to follow-up.
    2. T score of ≤-2.5 on DXA scan at L- spine, total hip, femoral neck, or distal 1/3 radius.
    3. Age <50 years.
    4. Creatinine clearance <60 mL/min.
    5. Increase in serum calcium level ≥ 0.25 mmol/L above upper limit of normal.

See 2008 Guidelines for the management of asymptomatic hyperparathyroidism: http://www.ncbi.nlm.nih.gov/pubmed/19193908


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