Laboratory of Experimental EndocrinologyIRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Laboratory of Experimental EndocrinologyIRCCS Istituto Ortopedico Galeazzi, Milan, Italy
Eur J Endocrinol. 2017 Jan;176(1):R39-R52. doi: 10.1530/EJE-16-0430. Epub 2016 Sep 6.
Primary hyperparathyroidism (PHPT) is the third most common endocrine disease. Kidney is a target of both chronic elevated PTH and calcium in PHPT. The classic PHPT complications of symptomatic kidney stones and nephrocalcinosis have become rare and the PHPT current presentation is asymptomatic with uncertain and long-lasting progression. Nonetheless, the routine use of imaging and of biochemical determinations have revealed the frequent occurrence of asymptomatic kidney stones, hypercalciuria and reduced kidney function in asymptomatic PHPT patients. Though the pathogenesis is far from being elucidated, PHPT is associated with reduced renal function, in terms of estimated glomerular filtration rate, and related increased morbidity and mortality. In the last decade, the effort of the Kidney Disease: Improving Global Outcomes (KDIGO) panel of experts highlighted that even mild reduction of kidney function is associated with increased risk of cardiovascular disease. These considerations provided the basis for the Fourth Workshop recommendations of a more extensive diagnostic workout about kidney features and of wider criteria for parathyroid surgery including asymptomatic kidney disease. Moreover, kidney involvement in PHPT is likely to be affected by variants of genes coding the key molecules regulating the calcium and ions renal handling; these features might have clinical relevance and should be considered both during diagnostic workout and follow-up. Finally, the effects of parathyroid surgery and of medical treatment on kidney involvement of PHPT are reviewed.
原发性甲状旁腺功能亢进症（PHPT）是第三大常见的内分泌疾病。肾脏是慢性升高的 PTH 和 PHPT 中钙的靶器官。经典的 PHPT 并发症如症状性肾结石和肾钙质沉着症已经变得罕见，而 PHPT 的当前表现为无症状，且具有不确定的、长期的进展。尽管常规使用影像学和生化测定已经揭示了无症状 PHPT 患者中无症状肾结石、高钙尿症和肾功能下降的频繁发生。尽管发病机制尚不清楚，但 PHPT 与肾功能下降有关，表现在估计肾小球滤过率方面，并且与发病率和死亡率增加相关。在过去十年中，肾脏病：改善全球结局（KDIGO）专家组的努力强调了即使是轻度肾功能下降也与心血管疾病风险增加有关。这些考虑为第四次研讨会关于肾脏特征的更广泛诊断工作以及甲状旁腺手术更广泛的标准提供了基础，包括无症状肾脏疾病。此外，调节钙和离子肾脏处理的关键分子的基因变异可能会影响 PHPT 中的肾脏受累；这些特征可能具有临床意义，应在诊断工作和随访中考虑。最后，回顾了甲状旁腺手术和药物治疗对 PHPT 肾脏受累的影响。
