What is your approach to managing patients with recurrent nephrolithiasis and nephrocalcinosis in the setting of hypoparathyroidism?

If patients truly have hypoparathyroidism, then the issue is to manage their hypocalemia, which usually requires large doses of oral calcium as well as treatment with VDRAs, which results in marked hypercalciuria, since they do not have PTH to help reabsorb calcium. This even occurs when they have CKD, which is usually associated with decreased urinary calcium. Since Natpara (PTH) is not presently on the market, except in same cases for compassionate use if the patient was previously on it, it is difficult to decrease supplemental calcium intake in these patients. Thus, the main focus is to increase fluid intake as much as possible and in some cases, I have been able to get Teriparatide or Abaloparatide approved to use and able to decrease ...