The Disclosure Dilemma — Large-Scale Adverse Events

Abstract

2471 The authors reply: We agree with Leaf that the risk associated with the use of vitamin D supple ­ ments (either nutritional or activated vitamin D compounds) is in the potential for overdose with resulting hypercalcemia and hypercalciuria. There are no data that we know of to suggest that cor ­ rection of vitamin D deficiency in patients with recurrent calcium stones is associated with ad ­ verse outcomes, and we agree with Leaf’s conclu ­ sions about the treatment of vitamin D deficiency in such patients. The blood level of 25 ­ hydroxyvi ­ tamin D should be monitored to prevent excessive ­ ly high levels of vitamin D from developing. This is an area in which further studies are needed. We also agree with Latta that in patients with persistent, severe hyperoxaluria, in the absence of enteric causes, the diagnosis of primary hy ­ peroxaluria should be considered. The diagnosis and treatment of these rare but severe inherited metabolic syndromes were beyond the scope of our review but have been well reviewed recently. 1 The work by Karim et al. 2 is of great interest, but it is worth noting that the commonly noted decrease in TmP/GFR in patients with recurrent calcium stones 3 does not necessarily increase the risk of phosphate­ containing stones. Patients with