Kitamura T, Hirano Y, Ueda D, Aso Y
Department of Urology, Branch Hospital, Faculty of Medicine, University of Tokyo, Japan.
Urol Res. 1988;16(3):149-55. doi: 10.1007/BF00256009.
116 normocalcemic and 8 primary hyperparathyroid (PHPT) patients with calcium (Ca) nephrolithiasis and 10 normal controls underwent 1 g of oral Ca tolerance test following 4 days of Ca restricted diet (400 mg/day). On the basis of urinary Ca/creatinine (Cr) ratio obtained by the test, the 116 patients with normocalcemic nephrolithiasis were divided into 3 groups (normocalciuric nephrolithiasis; NN, absorptive hypercalciuria; AH, renal hypercalciuria; RH) according to our criteria which were slightly modified from Pak et al. Changes in urinary Ca/Cr ratio, and those in serum Ca and phosphorus (P), tubular maximum reabsorption of phosphate/glomerular filtration rate (TmPO4/GFR), nephrogenous adenosine 3',5'-monophosphate (NcAMP) and plasma immunoreactive parathyroid hormone (iPTH) were determined. As a result, the 116 patients were divided into 82NN, 13AH and 21RH. In general, a rise in serum Ca and fall in NcAMP were seen first, followed by rises in urinary Ca/Cr ratio, serum P and TmPO4/GFR although the changes were small. The group PHPT showed abnormality in the changes of TmPO4/GFR, NcAMP and plasma iPTH. The former one decreased constantly during the test and the latter two did not fall to within the normal range, suggesting parathyroid autonomy or abnormal suppressibility. Regarding the normal controls, all the changes were smallest among the 5 groups and clear parathyroid suppression was not observed while it was seen in the groups NN, AH and RH. In conclusion, oral Ca tolerance test is useful not only to separate NN, AH and RH, but also for the diagnosis of PHPT by demonstrating parathyroid autonomy or abnormal suppressibility assessed by NcAMP and/or TmPO4/GFR.
116例血钙正常和8例原发性甲状旁腺功能亢进（PHPT）合并钙性肾结石患者以及10名正常对照者在进行4天钙限制饮食（400毫克/天）后接受了1克口服钙耐量试验。根据试验获得的尿钙/肌酐（Cr）比值，将116例血钙正常的肾结石患者按照我们在Pak等人标准基础上稍作修改的标准分为3组（正常钙尿性肾结石；NN，吸收性高钙尿症；AH，肾性高钙尿症；RH）。测定尿钙/Cr比值、血清钙和磷（P）、肾小管最大磷重吸收/肾小球滤过率（TmPO4/GFR）、肾源性腺苷3',5'-单磷酸（NcAMP）以及血浆免疫反应性甲状旁腺激素（iPTH）的变化。结果，116例患者分为82例NN、13例AH和21例RH。总体而言，血清钙升高和NcAMP下降先出现，随后尿钙/Cr比值、血清P和TmPO4/GFR升高，尽管变化较小。PHPT组在TmPO4/GFR、NcAMP和血浆iPTH的变化方面表现异常。前者在试验期间持续下降，后两者未降至正常范围内，提示甲状旁腺自主性或抑制异常。对于正常对照者，所有变化在5组中最小，未观察到明显的甲状旁腺抑制，而在NN、AH和RH组中观察到了甲状旁腺抑制。总之，口服钙耐量试验不仅有助于区分NN、AH和RH，还可通过显示由NcAMP和/或TmPO4/GFR评估的甲状旁腺自主性或抑制异常来诊断PHPT。
