Urinary calcium excretion >400 mg/day, known as hypercalciuria, is a significant indication for parathyroidectomy in patients with primary hyperparathyroidism (PHPT). This high level of calcium in the urine increases the risk of kidney stones, kidney damage, and other long-term complications. Parathyroidectomy, which removes the overactive parathyroid glands, can help normalize calcium excretion and reduce these risks.
Here’s why hypercalciuria is a key indicator:
Increased risk of kidney stones:
High calcium levels in the urine can contribute to the formation of calcium-containing kidney stones, which can cause pain, bleeding, and urinary tract infections.
Potential for renal damage:
Prolonged hypercalciuria can lead to nephrocalcinosis (calcium deposits in the kidneys) and chronic kidney disease.
Improved bone health:
Parathyroidectomy can lead to improvements in bone mineral density and reduced risk of fractures.
Normalization of calcium levels:
Surgery can normalize calcium excretion and help manage hypercalcemia, a condition characterized by high blood calcium levels.
While other factors, like significant renal impairment, osteoporosis, or hypercalcemia, are also indications for surgery, hypercalciuria is a strong and well-established reason for considering parathyroidectomy in PHPT patients.