Elevation of serum uric acid levels by calcium restricted diet
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We investigated whether calcium restricted diet is a direct cause of the serum uric acid elevation in renal stone patients. Serum calcium, phosphorus, uric acid, magnesium and creatinine, and their 24-hour urinary excretion were measured in three groups of individuals consisting of 21 renal stone patients with normocalciuria,25 with idiopathic hypercalciuria and 20 with primary hyperparathyroidism, under both normal diet and a calcium restricted diet. Calcium loading test was performed in idiopathic hypercalciuria patients. In the calcium restricted study, serum uric acid values were elevated in all groups, being significant in the idiopathic hypercalciuria and hyperparathyroidism groups. In females serum uric acid levels were elevated in all groups, while such elevation was found only in male idiopathic hypercalciuria patients. Calcium loading test in the idiopathic hypercalciuric group revealed a significant reduction of urinary excretion of uric acid. In the calcium restricted diet study, serum uric acid values were elevated and urinary excretion of calcium was reduced. The latter is presumably due to an increased renal tubular reabsorption of calcium caused by elevated serum parathyroid hormone. However, hyperuricemia is not always associated with primary hyperparathyroidism. In addition, calcium loading test caused a decrease in urinary excretion of uric acid. These findings suggest that the elevation of serum uric acid values by calcium restriction is not caused by the changes of serum parathyroid hormone levels.
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