Hypercalciuria Associated With Long-term Administration of Calcitriol (1,25-Dihydroxyvitamin D3) Action of Hydrochlorothiazide

doi:10.1001/archpedi.1986.02140160057032

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Vol. 140 No. 2, February 1986

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Hypercalciuria Associated With Long-term Administration of Calcitriol (1,25-Dihydroxyvitamin D₃)

Action of Hydrochlorothiazide

Fernando Santos, MD; M. J. Vernon Smith, MD, PhD; James C. M. Chan, MD

Am J Dis Child. 1986;140(2):139-142.

Abstract

• Urine calcium excretion was evaluated in 19 patientsbefore and after calcitriol (1,25-dihydroxyvitamin D₃) treatmentthat was followed up for a five- to seven-year period. The effectsof increases of calcitriol dosage and modifications of calciuriawith hydrochlorothiazide were systematically examined. The urinecalcium excretion before calcitriol therapy was 2.3±0.8mg/kg/day (mean-± SEM) and the urine calcium-creatinineconcentration ratio was 0.12±0.04. With the dose of calcitriolat 23 ng/kg/day, these values increased to 3.2±0.8 mg/kg/dayand 0.19±0.04, respectively. Following double dose ofcalcitriol (44 ng/kg/day), increments in calciuria and urinarycalcium/creatinine concentration of 1.4±0.6 mg/kg/dayand 0.10±0.03, respectively, were observed. With concomitantadministration of hydrochlorothiazide (1 to 2 mg/kg/day) therapyat maintenance dose and calcitriol (31 ng/kg/day), the urinecalcium excretion effectively decreased by 1.3±0.6 mg/kg/dayand the urine calcium-creatinine concentration ratio by 0.05± 0.02. The results suggest that children with calcium-phosphatedisorders who require long-term treatment with calcitriol mustbe carefully monitored in terms of urine calcium excretion,especially when the dosages are increased to achieve maximaltherapeutic efficacy. Calciuria induced by calcitriol administrationis effectively reversed by addition of hydrochlorothiazide tothe treatment regimen.

(AJDC 1986;140:139-142)

Author Affiliations

From the Children's Medical Center (Drs Santos, Smith, and Chan) and the Departments of Surgery (Dr Smith) and Pediatrics (Drs Santos and Chan), Medical College of Virginia, Health Sciences Division of Virginia Commonwealth University, Richmond. After sabbatical leave during which he did this work, Dr Santos is now back at Children's Hospital Instituto Nacional de la Salud and the University of Oviedo, Asturias, Spain.

Footnotes

Accepted for publication Oct 3, 1985.

Reprint requests to Medical College of Virginia Station, Box498, Richmond, VA 23298 (Dr Chan).

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