Department of Urology, University of California, San Francisco, CA, USA.
Surgery. 2012 Mar;151(3):477-83. doi: 10.1016/j.surg.2011.07.039. Epub 2011 Sep 3.
Hyperparathyroidism is associated with hypercalciuria and nephrolithiasis. Urine calcium excretion decreases after parathyroidectomy, but whether there is a differential decrease between stone and nonstone formers remains controversial. We evaluated differences between stone formers and non-stone formers in serum and urinary parameters before and after parathyroidectomy.
90 patients, 40 with and 50 without a history of nephrolithiasis underwent parathyroidectomy for hyperparathyroidism; 24-hour urine samples were collected before and after parathyroidectomy. Overall, 92% of patients provided samples before parathyroidectomy and 63% after parathyroidectomy. Preoperative, postoperative and changes in urinary parameters were evaluated.
Preoperative hypercalciuria was present in ∼65% in both groups (P = .68). Parathyroidectomy decreased serum levels of calcium, parathyroid hormone, and urinary calcium, but there were no differences between stone formers and nonstone formers. Stone formers were 12-fold (P = .001) more likely to resolve an increase in supersaturation of calcium oxalate (SSCaOx), and after adjustment for age, sex, and BMI were 46-fold (P = .002) more likely to resolve an increase in SSCaOx. After parathyroidectomy, the rate of stone recurrence was 23% and male sex (aOR 20, P = .032) and increasing BMI (aOR 1.23, P = .038) were the only independent predictors of stone recurrence after adjusting for age. No other factor evaluated preoperatively, postoperatively, or the change after parathyroidectomy differentiated stone and nonstone formers or predicted stone recurrence.
Metabolic evaluation did not differentiate stone formers from nonstone formers reliably. Stone formers were more likely to resolve an increase in SSCaOx after parathyroidectomy. Male sex and increasing BMI were independently associated with stone recurrence after parathyroidectomy.
甲状旁腺功能亢进与高钙尿症和肾结石有关。甲状旁腺切除术后尿钙排泄减少，但结石形成者和非结石形成者之间是否存在差异仍存在争议。我们评估了甲状旁腺切除术前和术后结石形成者和非结石形成者之间血清和尿液参数的差异。
90 例患者，40 例有肾结石病史，50 例无肾结石病史，因甲状旁腺功能亢进行甲状旁腺切除术；收集甲状旁腺切除术前和术后 24 小时尿液样本。总体而言，92%的患者在甲状旁腺切除术前提供了样本，63%的患者在甲状旁腺切除术后提供了样本。评估了术前、术后和尿液参数的变化。
两组术前均有约 65%存在高钙尿症（P =.68）。甲状旁腺切除术后血清钙、甲状旁腺激素和尿钙水平降低，但结石形成者和非结石形成者之间无差异。结石形成者更有可能解决草酸钙过饱和度（SSCaOx）的增加（P =.001），并且在调整年龄、性别和 BMI 后，结石形成者更有可能解决 SSCaOx 的增加（P =.002）。甲状旁腺切除术后，结石复发率为 23%，男性（优势比 20，P =.032）和 BMI 增加（优势比 1.23，P =.038）是调整年龄后结石复发的唯一独立预测因素。在调整年龄后，术前、术后或甲状旁腺切除术后的变化没有其他因素可区分结石形成者和非结石形成者或预测结石复发。
代谢评估不能可靠地区分结石形成者和非结石形成者。甲状旁腺切除术后，结石形成者更有可能解决 SSCaOx 的增加。男性和 BMI 增加与甲状旁腺切除术后结石复发独立相关。
