Calcium and vit d question

[anonymous_825]

Hi all. I posted this at the bottom of my last post a few months ago but thought it might be a pain to get to so decided to post a fresh topic.

Sorry I haven't been on in a while...life has been so busy.

I finally had my appt with the rheumatologist and he doesn't think I display any physical symptoms of lupus (rash, lupus hair) he did run the ANA and some additional tests to be sure.  I got some results but not the ANA yet.

Of course there are new questions and I knew you all would have the best information.

So my serum calcium is at 10.0, which is borderline high.  What I've read is that for over 30 is should be 10.1 or lower (the lab range says 10.4, but from what I've read that is for teens and possibly twenties, neither of which I am!).
Couple of months ago it was 9.6.

My urine calc ox was >5 flagged HIGH.

Also a test called eGFR-Afr Am >59, eGFR-Non-Afr Am >59

The range says >60, so I assume that >59 is the same and just weird they have it so close but different.  But throwing it out b/c it has to do with kidneys and so does the urine calc ox.

So here's where I'm confused, and want to make sure b/c think the docs may just brush this off, so just want to make sure I understand.

Did the vit d supp cause the rise in calcium, both serum and urine?  

I've read that pth levels can lower vit d and you shouldn't supp vit d if you have a parathyroid disorder until it is identified and resolved.  And that pth regulates how much calcium is in your blood etc.  and that high levels of calcium are bad.

So chicken or egg?  Is the vit d causing the rise in calcium?   My vit d with full supp has only gotten to 50, then dipped to 30 again and now is at 45.  When I started the supp it was 9.

Should my pth have been checked then, and my calcium levels?

Can they be checked now or has the supp skewed the results?

Should I stop the d supp since my calcium now seems to have gone overboard?  I don't want calcium deposits.  

There are several other tests done, which I'm happy to share, but seems they are all normal so just let me know if you need anything else to help complete the picture.

Thanks so much everyone!

[Red_Star]

No I just read my comment (sorry I'm really tired and need to go to bed) and it doesn't make sense LOL. I probably should of said your kidneys are probably not processing the calcium oxalate like a normal kidney would.  I thought I'd have a quick look online before I log off and found this...

"Hyperoxaluria is uncommon. In some people the cause of the excess urine oxalate is not known but may result from changes in the way kidneys handle normal amounts of body oxalate."

***

Here is a long list of causes for high calcium...

Most common (primary hyperparathyroidism and malignancy account for
90% of hypercalcemic patients):

Primary hyperparathyroidism

Malignant disease:
- PTH-related protein (carcinoma of lung, esophagus, head and neck,
renal cell, breast, ovary, and bladder)
- Ectopic production of 1,25-dihydroxyvitamin D (lymphoma)
- Lytic bone metastases (multiple myeloma, hematologic
malignancies and breast carcinoma)
- Other factor(s) produced locally or ectopically

Uncommon:

Endocrine disorders:
- Thyrotoxicosis

Granulomatous diseases:
- Sarcoidosis
- HIV

Drug-induced:
- Vitamin D
- Thiazide diuretics
- Lithium
- Estrogens and antiestrogens
- Androgens (breast cancer therapy)
- Aminophylline
- Vitamin A
- Aluminum intoxication (in chronic renal failure)

Miscellaneous:
- Immobilization
- Renal failure (acute and chronic)
- Total parenteral nutrition

Rare:

Endocrine disorders:
- Pheochromocytoma
- Vasoactive intestinal polypeptide-producing tumor
- Familial hypocalciuric hypercalcemia

Granulomatous diseases:
- Tuberculosis
- Histoplasmosis
- Coccidioidomycosis
- Leprosy

Miscellaneous:
- Milk-alkali syndrome
- Hypophosphatasia
- William’s syndrome
- Rhabdomyolysis (presentation is usually preceded by a hypocalcemic
state)

[anonymous_825]

Ha. I had a cystoscope and ct scan about 10 years ago.  They did not find anything wrong.  My ob/gyn told me I had blood in urine with my pregnancies dating back to the 90s.  Yep, the urologist wrote it off as my normal.

I haven't had any kidney scans.  Not even sure if they ever checked my urine for calcium oxalate before. So don't know if this is new or if I've had it for a while.  

I don't know what made the rheum check it.

Can you clarify what you mean...or how it works.  If the kidneys excrete, presumably through urine, 90% of calcium oxalate, wouldn't you then expect the level to be high in the urine?  Or is it the high in the urine and the high normal serum that isn't efficient?

Not questioning you but I don't understand.

Honestly, I feel like I see a doc for one thing and then something else comes up and sends us down another oath and I keep going in circles.

Just need to figure out what to do next.  I don't like the idea of high calcium and the damage and need to determine how to fix this.

Thanks again!

[Red_Star]

Blood in urine for 15 + years...is your normal? Ummm if the doctor told me that I'd be giving him the one eyebrow raised look O_o LOL.

High blood calcium levels can be found in people with slow or reduced kidney function as well. A healthy kidney excretes more than 90% of calcium oxalate but it sounds like your kidneys aren't clearing this out efficiency.

Elevated calcium oxalate does put you are higher risk for kidney stones. Calcium oxlate stones are the most common type kidney stone. Have you ever had a kidney scan? My mother had one and found a few cysts in her kidneys.

I have read that if you have early stage kidney disease don't usually need to limit water intake but with late stage kidney disease and on dialysis you may be put on strict fluid restrictions.

[anonymous_825]

Also, does the high urine calc ox mean I have kidney stones or just a higher risk to develop them?

Could it indicate anything else?

Anything I can/should do?  Drink more water? Or will it only continue this trend?

Don't have anything bothering me other than the years of fatigue and then more recently the numbness and tingling. Every other issue (constipation, memory kind of things) has been more annoyance than problem, if that makes sense.

Thanks again for the input.

[anonymous_825]

Thanks red star.  I take magnesium and k2 with my vitamin d.

It was the high calc ox in the urine that alarmed me.  Then I saw that serum calcium was now 10.0, having been in the mid-9s.

Then thought that maybe it was the vit d supp that caused the calcium rise and then wasn't sure what to do.

Googling it (not advisable) sent me to parathyroid and I guess a good site that said low vit d levels can be indicative of hyperparathyroidism and that you should not supplement with vit d until the parathyroid issue is resolved.

So, do I get the pth checked? Or now that my vit d levels are "normal" will that make the pth test valueless?

I think the eGFR is okay b/c it says it is greater than 59 and the normal is greater than or equal to 60.  But 59 is stage 3 so I kind of got nervous when I first read it. However, I don't think it means I am 59 or 60 but just in the stage 2 (or 1).  I have had blood in urine for 15+ years and saw a urologist and did cystoscope, etc., etc, and found nothing, so told that was my normal.

Thanks again. The rheum said he would call if he saw anything alarming. I haven't heard from him so I'm guessing they are not concerned.

Just thought I needed a better understanding of the relationships of these things and if I should do further testing.

Not sure why the rheum did the tests re: kidney.  Any ideas why he would look that way?

[Red_Star]

"In the event of calcification, it is not particularly a high calcium level that results in the formation of a stone or spur, but calcium being high in ratio to magnesium." - Calcification and Its Treatment with Magnesium and Sodium Thiosulfate.

Very true! I had a magnesium deficiency and calcified my mitral heart valve and who knows what else.  I didn't develop any kidney stones as I drink a lot of water.  Dehydration is the #1 cause of kidney stones.

Vitamin D is needed to absorb calcium and it can be a possible reason for high calcium levels although it's listed as an uncommon cause. Ionized calcium is more accurate than calcium serum.  It's worth checking PTH just to be on the safe side.

The eGFR (estimated glomerular filtration rate) is the % your kidney function is at.  Because eGFR estimation is not very accurate at near normal levels of kidney function, many labs only report eGFR >60 so you cannot tell the difference between stage 1 and 2 of chronic kidney disease - both of which are above 60% function. My lab lists eGRF >90 though.  Other abnormalities such as having blood or protein in the urine may lead to a diagnosis of chronic kidney disease despite normal or nearly normal eGFR.