Perez Alberto A, Schneider David F, Long Kristin L, Pitt Susan C, Sippel Rebecca S
Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
J Surg Res. 2018 Dec;232:564-569. doi: 10.1016/j.jss.2018.07.028. Epub 2018 Aug 7.
Nephrolithiasis is a classic, treatable manifestation of primary hyperparathyroidism (PHPT). We examined predictors of kidney stone formation in PHPT patients and determined how efficiently the diagnosis of PHPT is made in patients whose initial presentation is with stones.
We performed a retrospective analysis of surgically treated PHPT patients, comparing 247 patients who were kidney stone formers and 1047 patients with no kidney stones. We also analyzed 51 stone-forming patients whose stone evaluation and treatment were completed within our health system before PHPT diagnosis.
Stone-forming patients had higher 24-h urinary calcium (342 versus 304 mg/d, P = 0.005), higher alkaline phosphatase (92 versus 85 IU/L, P = 0.012), and were more likely to be normocalcemic (26.6% versus 16.9%, P = 0.001). Surprisingly, 47.3% of stone formers had normal urinary calcium levels (<300 mg/d). Of the 51 stone-forming patients treated at our institution, serum calcium was measured within 6 mo of stone diagnosis in 37 (72.5%) patients. Only 16 (31.4%) of these patients had elevated calcium levels, and only 10 (62.5%) of these 16 had a serum parathyroid hormone ordered within the following 3 mo. These patients had a significantly shorter time from their first stone to surgical treatment compared to other patients (median 8.5 versus 49.1 mo, P = 0.001).
Elevated serum and urinary calcium levels are not evaluated in the majority of PHPT patients presenting with kidney stones. In nephrolithiasis patients, provider consideration of PHPT with prompt serum calcium and parathyroid hormone evaluation significantly reduces time to treatment.
肾结石是原发性甲状旁腺功能亢进症（PHPT）的一种典型且可治疗的表现。我们研究了PHPT患者肾结石形成的预测因素，并确定在最初表现为结石的患者中PHPT的诊断效率如何。
我们对接受手术治疗的PHPT患者进行了回顾性分析，比较了247例肾结石形成者和1047例无肾结石患者。我们还分析了51例在PHPT诊断之前在我们的医疗系统内完成结石评估和治疗的结石形成患者。
结石形成患者的24小时尿钙水平较高（342对304mg/d，P = 0.005），碱性磷酸酶较高（92对85IU/L，P = 0.012），且更可能血钙正常（26.6%对16.9%，P = 0.001）。令人惊讶的是，47.3%的结石形成者尿钙水平正常（<300mg/d）。在我们机构接受治疗的51例结石形成患者中，37例（72.5%）在结石诊断后6个月内测量了血清钙。这些患者中只有16例（31.4%）血钙水平升高，在这16例患者中，只有10例（62.5%）在接下来的3个月内进行了血清甲状旁腺激素检测。与其他患者相比，这些患者从首次结石到手术治疗的时间明显更短（中位数8.5对49.1个月，P = 0.001）。
大多数以肾结石就诊的PHPT患者未评估血清和尿钙水平。在肾结石患者中，医疗人员考虑PHPT并及时进行血清钙和甲状旁腺激素评估可显著缩短治疗时间。
