increased calcium in thiazides

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step1april2013

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Why is there increased paracellular reabsorption of calcium in the proximal tubule and loop of henle when using thiazides

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In the proximal tubule, thiazides are thought to increase the action of PTH. Loop diuretics decrease calcium reabsorption in the thick ascending limb of the loop of Henle as a result of the inhibition of the Na-K-Cl transporter (Ca needs Na to be reabsorbed in this portion). Thiazides work in the distal tubule to inhibit NaCl reabsorption, and they increase calcium reabsorption. Im not entirely clear about the exact mechanism of this, but I think it is sufficient to know that loop diuretics induce hypocalcemia and thiazides induce hypercalcemia.
 
Thiazides block apical NaCl, lowering Na inside the cell. This creates a gradient for the basolateral Na/Ca countertransporter, shifting Na into the cell and Ca into blood causing hypercalcemia.
 
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