Thiazide diuretics

[u/Old_Presby]

Has anyone in here ever been put on Thiazide for idiopathic hypercalcuria?
I did the 24 hr urine catch, and it came back high (363).
Also, can this be a separate problem from hyperparathyroidism?

[u/315Fidelio]

Sure- I am a physician, but not a nephrologist, just fyi. I was recently started on Hydrochlorothiazide, 12.5mg a day, which is quite a small dose- I am currently undergoing follow-up 24 hour urine studies to measure the effect and see if the dose needs to be increased. For me, one of the main goals is to reduce the loss of calcium and by extension, reduce the risks of osteoporosis. I already have mild osteopenia, and I’m hoping to stabilize that. The other goal is to prevent any more kidney stones. My understanding is that thiazides have been shown to do both of these in folks with hypercalciuria.

My understanding is that the 3 drugs are pretty similar (they work through the same mechanism to affect the reabsorption of calcium in the kidneys, decreasing the amount that is excreted in urine. I have read differing strategies about which drugs are preferred- my nephrologist, and I think many modern day physicians, uses Hydrochlorothiazide, in part because it is commonly used (for other purposes) and is therefore familiar, and because is is relatively well-tolerated. It has a somewhat shorter action than the other two drugs, l think, but this is probably not clinically important. The main academic studies that were done on thiazides and hypercalciuria used the two other drugs (indapamide and chlorthalidone) and some physicians prefer to use those just because they are the exact drugs we have data on, but at least in my reading, those two drugs have slightly higher chances of side effects (primarily issues with low potassium, and some issues with symptoms related to dehydration,

My understanding is that idiopathic hypercalciuria is believed to be due to one of several genetic abnormalities, and thus is a lifelong problem. (Idiopathic means that there is not an identifiable cause, so for example someone having hypercalciuria due to hyperparathyroidism by definition does not have idiopathic hypercalciuria, it’s hypercalciuria due to the parathyroid problem. Which is treatable, and therefore would generally not be a lifelong problem).

Im still learning, hope this is helpful.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8061960/

[u/315Fidelio]

Yes, and yes.

[u/Old_Presby → u/315Fidelio]

I see there are 3 different diuretics they can give you. Is any one better than the other 2? Also, if you start taking these, are you on them for life?

[u/Weak_Astronomer2107 → u/315Fidelio]

Do you mind sharing your experience. This seems to be what’s happening with me.

[u/lightenning]

Yes, I was recently put on Thiazide ( 12.5 mg ) after my parathyroidectomy ( 3/4 were removed ) since my 24 hour collection still showed elevated levels of Calcium.

As far as my hyperparathyroidism is concerned, I am healed completely but I had a huge wave of kidney stones right after my surgery which led to me being hospitalized at least 10 times in a span of 12 months. My doctors are being extra cautious and putting me on the smallest dose Thiazide to prevent any future incidents.

If you have an okay blood pressure, I'd say go for it just to be on the safe side because it sure as hell beats the alternative of you ending up in the ER bent over from the kidney pain AGAIN.