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Parathyroidectomy Stone Recurrence Reduction PHPT — ESENeph MCQ

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ModerateRenal Stone DiseaseParathyroidectomy Stone Recurrence Reduction PHPTESENeph

A 44-year-old woman with CKD G3a (eGFR 55 mL/min/1.73m2) and recurrent calcium oxalate stones is found to have primary hyperparathyroidism (PTH 12 pmol/L, calcium 2.78 mmol/L). She meets surgical criteria. After successful parathyroidectomy, what effect does this have on stone recurrence risk?

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Correct answer: D — Significantly reduces stone recurrence by correcting hypercalciuria

Primary hyperparathyroidism (PHPT) is a correctable cause of recurrent nephrolithiasis. Elevated PTH causes hypercalciuria (via increased filtered calcium load and possibly direct tubular effects), which drives calcium stone formation. Parathyroidectomy normalises calcium homeostasis, reduces urinary calcium excretion, and significantly reduces stone recurrence rates. The 2022 International Workshop on PHPT recommends parathyroidectomy for all symptomatic patients (including those with nephrolithiasis) and for asymptomatic patients meeting specific criteria (age <50, calcium >0.25 mmol/L above ULN, eGFR <60, nephrocalcinosis, or vertebral fracture). Post-operatively, transient hypocalcaemia (hungry bone syndrome) requires monitoring but does not promote stones.

Reference: Bilezikian et al 2022 – PHPT International Workshop; EAU 2023 – Urolithiasis