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Table 1. Definitions of Hypercalciuria

Diet	Definition
Regular diet (unrestricted)	Women: Urinary excretion >250 mg calcium (6.2 mmol/24 h) Men: Urinary excretion >275-300 mg calcium (7.5 mmol/24 h)
Regular diet (unrestricted)	Urinary excretion >4 mg calcium (0.1 mmol) per kilogram of body weight per day Urinary concentration >200 mg calcium per liter
Restricted diet (400 mg calcium, 100 mEq sodium)	Urinary excretion >200 mg calcium per day
Restricted diet (400 mg calcium, 100 mEq sodium)	Urinary excretion >3 mg calcium per kilogram of body weight per day

Table 2. Hypercalciuria Simplified Test Guideline

Hypercalciuria Diagnosis	Urinary Calcium on 400-mg Calcium Diet (Normal = < 200 mg/24 h)	Fasting Calcium/Creatinine (mg/dL) Ratio (Normal = < 0.11)	Post–Calcium Load Calcium/Creatinine Ratio (Normal = < 0.20)
Normal	Normal	Normal	Normal
Absorptive type I	High	Normal	High
Absorptive type II	Normal	Normal	High
Absorptive type III (renal phosphate leak)	High	High	High
Renal leak	High	High	High
Resorptive (hyperparathyroidism)	High	High	High

Table 3. Calcium-Loading Test Interpretation Guide

Criteria	Absorptive Type I Vitamin D–Dependent (Classic Form)	Absorptive Type I Vitamin D–Dependent (Variant Form)	Absorptive Type II Dietary Calcium Responsive	Absorptive Type III (Renal Phosphate Leak)	Renal Calcium Leak	Resorptive
Urinary calcium on regular diet^*	High	High	High	High	High	High
Urinary calcium on low-calcium diet^†	High	High	NL	High	High	High
Urinary calcium fasting^‡	NL	High	NL	High	High	High
Urinary calcium after 1-g calcium load^§	High	High	NL	High	High	High
Serum PO₄ (fasting)	NL	NL	NL	Low	NL or high	Low
Serum calcium (fasting)	NL	NL or high	NL	NL or high	NL or low	High
Serum PTH	NL or low	NL or low	NL	Low	High	High
Serum PTH after 1-g calcium load	NL or low	NL or low	NL	Low	High	High
Serum vitamin D3 (calcitriol)	NL	High	NL	High	High	High
Fasting normocalciuria while on ketoconazole	No	Yes	No	Yes	No	No
Bone calcium density	NL	NL or low	NL	NL or low	Low	Low
NL = normal; PO₄ = phosphate; PTH = parathyroid hormone. ^* Regular diet is unrestricted calcium and sodium intake. Normal upper limit calciuria is < 4 mg/kg body weight per day. ^† Low-calcium diet is 400 mg calcium and 100 mEq of sodium per day. Normal upper limit calciuria is < 200 mg/day. ^‡ Fasting is a 12-hour fast. Normal upper limit is < 0.11 mg calcium/mg creatinine. ^§ After 1-g calcium load, normal upper limit is < 0.20 mg calcium/mg creatinine.

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Author

Stephen W Leslie, MD, FACS Founder and Medical Director, Lorain Kidney Stone Research Center; Associate Professor of Surgery, Creighton University School of Medicine, Chief of Urology, Creighton University Medical Center

Stephen W Leslie, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, National Kidney Foundation, Ohio State Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Sahar Fathallah-Shaykh, MD Professor of Pediatrics, University of Alabama at Birmingham School of Medicine; Medical Director of Pediatric Dialysis Unit, Division of Pediatric Nephrology, Children's of Alabama

Sahar Fathallah-Shaykh, MD is a member of the following medical societies: American Society of Nephrology, American Society of Pediatric Nephrology

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FASN Professor of Medicine, Section of Nephrology-Hypertension, Deming Department of Medicine, Tulane University School of Medicine

Vecihi Batuman, MD, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Acknowledgements

Sahar Fathallah-Shaykh, MD Assistant Professor in Pediatric Nephrology, University of Alabama at Birmingham School of Medicine; Consulting Staff, Division of Pediatric Nephrology, Medical Director of Pediatric Dialysis Unit, Children's of Alabama

Sahar Fathallah-Shaykh, MD is a member of the following medical societies: American Society of Nephrology and American Society of Pediatric Nephrology

Disclosure: Medscape Reference Honoraria Other

Frederick J Kaskel, MD, PhD Director of the Division and Training Program in Pediatric Nephrology, Vice Chair, Department of Pediatrics, Montefiore Medical Center and Albert Einstein School of Medicine

Frederick J Kaskel, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Pediatric Society, American Physiological Society, American Society of Nephrology, American Society of Pediatric Nephrology, American Society of Transplantation, Eastern Society for Pediatric Research, Federation of American Societies for Experimental Biology, International Society of Nephrology, NationalKidneyFoundation, New York Academy of Sciences, Renal Physicians Association, Sigma Xi, and Society for Pediatric Research