High Rate of Occult Urolithiasis in Normocalcemic Primary Hyperparathyroidism
| Autor: | Patricia Moura Cravo Teixeira, Leonardo Bandeira, Francisco Bandeira, Sérgio Andrade, Lívia Laeny Henrique Pontes, Elba Bandeira, Alyne Layane Pereira Lemos |
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| Rok vydání: | 2019 |
| Předmět: |
Male
lcsh:Diseases of the circulatory (Cardiovascular) system medicine.medical_specialty Primary hyperparathyroidism Normocalcemia 030232 urology & nephrology Urology Parathyroid hormone Renal function Nephrolithiasis lcsh:RC870-923 Asymptomatic 03 medical and health sciences 0302 clinical medicine Urolithiasis lcsh:Dermatology Medicine Humans Thiazide business.industry General Medicine lcsh:RL1-803 Middle Aged lcsh:Diseases of the genitourinary system. Urology medicine.disease Hyperparathyroidism Primary Urinary calcium lcsh:RC666-701 Nephrology Kidney stones Secondary hyperparathyroidism Female medicine.symptom Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Kidney & Blood Pressure Research, Vol 44, Iss 5, Pp 1189-1195 (2019) |
| ISSN: | 1423-0143 |
| Popis: | Introduction: Normocalcemic primary hyperparathyroidism (NPHPT) is characterized by elevations in serum parathyroid hormone levels in the presence of normal serum calcium concentrations after exclusion of secondary hyperparathyroidism. We have previously demonstrated no differences in the prevalence of clinically active urolithiasis between NPHPT and hypercalcemic asymptomatic PHPT, and that it is significantly higher in postmenopausal osteoporotic women with NPHPT in comparison to women with normal serum PTH and calcium concentrations. Few studies have addressed the occurrence of silent or occult kidney stones in asymptomatic hypercalcemic PHPT, but no data are available for NPHPT. Objective: To determine the presence of occult urolithiasis in NPHPT patients using routine abdominal ultrasonography. Methods and Results: We studied 35 patients with NPHPT (mean age 63.2 ± 10.7 years, 96% women; serum PTH 116.5 ± 39.2 pg/mL, 25OHD 38.5 ± 6.82 ng/mL, total calcium 9.1 ± 0.56 mg/dL; albumin 4.02 ± 0.37 g/dL; BUN 34.35 ±10.23 mg/dL; p = 3.51 ± 0.60 mg/dL; estimated glomerular filtration rate 88.44 ± 32.45 mL/min/1.73 m2, and 24-h urinary calcium excretion 140.6 ± 94.3 mg/24 h). The criteria for the diagnosis of NPHPT were as follows: serum PTH above the reference range (11–65 pg/mL), normal albumin-corrected serum calcium concentrations, normal 24-h urinary calcium excretion, serum 25OHD above 30 ng/mL, estimated GFR (MDRD) above 60 mL/min/1.73 m2 (with the exclusion of medications such as thiazide diuretics, lithium, bisphosphonates, and denosumab), a history of clinical symptoms of urolithiasis, and a family history of kidney stones. Thirty-five patients were evaluated and 25 of them met the inclusion criteria. Five patients presented nephrolithiasis corresponding to 20% of the study population. There were no statistically significant differences in any of the clinical or laboratory variables studied between patients with or without urolithiasis, although mean serum PTH levels were higher in patients with stones (180.06 ± 126.48 vs. 100.72 ± 25.28 pg/mL, p = 0.1). The size of the stones ranged from 0.6 to 0.9 cm and all of the stones were located in the renal pelvis. Conclusion: We found a high prevalence of occult kidney stones in NPHPT patients, similar to what is observed in clinically manifested urolithiasis, in hypercalcemic PHPT. |
| Databáze: | OpenAIRE |
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