102. Renal Tubular Physiology of Calcium Excretion

  1. Clifford J. Rosen MD
  1. Peter A. Friedman and
  2. David A. Bushinsky

Published Online: 19 JUL 2013

DOI: 10.1002/9781118453926.ch102

Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition

Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition

How to Cite

Friedman, P. A. and Bushinsky, D. A. (2013) Renal Tubular Physiology of Calcium Excretion, in Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition (ed C. J. Rosen), John Wiley & Sons, Inc., Ames, USA. doi: 10.1002/9781118453926.ch102

Publication History

  1. Published Online: 19 JUL 2013

ISBN Information

Print ISBN: 9781118453889

Online ISBN: 9781118453926

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Keywords:

  • calcium excretion;
  • distal tubule;
  • diuretics;
  • genetic hypercalciuric stone-forming rats;
  • Henle's loop;
  • proximal tubule;
  • renal tubular physiology

Summary

The kidneys are primarily responsible for control of extracellular calcium balance. Renal calcium absorption occurs by a series of sequential events as the urine passes through the nephron. Most of the filtered calcium is recovered by proximal tubules, with progressively smaller fractions retrieved as the insipient urine passes through consecutive tubule segments. Thin descending and ascending limbs of Henle's loop exhibit low calcium permeability and do not contribute meaningfully to calcium economy. Distal convoluted tubules reabsorb 5—10% of the filtered calcium. Thiazide diuretics and functionally related agents such as metolazone have the unique ability to decrease renal calcium excretion, especially upon chronic administration, while simultaneously increasing sodium excretion. The primary end point for successful treatment of patients with calcium-containing kidney stones is a decrease in the rate of stone recurrence. The majority of human kidney stone formers with calcium-containing kidney stones are hypercalciuric when compared to non-stone formers.