Turk J Med Sci. 2019 Feb 11;49(1):295-300. doi: 10.3906/sag-1806-181.
BACKGROUND/AIM: Prolonged hypercalcemia impairs renal function, and a reduced glomerular filtration rate (GFR) is typical in advanced primary hyperparathyroidism (PHPT). There are scarce data related to predictors of renal impairment in patients with PHPT. Hence, we aimed to evaluate changes in kidney function in PHPT patients after parathyroidectomy (PTX) and identify factors associated with GFR variation in these patients.
One hundred and twenty-five patients with PHPT who underwent surgery between 2012 and 2014 were enrolled in the study. Patients were divided into two groups according to GFR values: patients whose GFR was lower than 60 mL/min/1.73 m2 and higher than 60 mL/min/1.73 m2. Demographic and laboratory parameters were compared before and 6 months after parathyroidectomy.
Prevalence of antihypertensive drug users and patients with renal cysts and parathormone (PTH) and alkaline phosphatase levels were higher in patients with GFR of ≥60 than in GFR of <60 mL/min/1.73 m2 (P < 0.05). Systolic BP, uric acid, and magnesium were decreased in patients with GFR of ≥60, but GFR did not change in the two groups after parathyroidectomy. After parathyroidectomy, calcium and PTH decreased but 25(OH)D3 and phosphorus increased in the two groups. In multiple regression analysis, age, calcium, and baseline GFR were independent predictors of GFR variation. Parathyroid adenoma volume and urinary calcium were not independent predictors of GFR change.
Olderage, higher preoperative calcium, and GFR were factors associated with GFR increase in PHPT patients after parathyroidectomy. Further renal impairment was prevented by parathyroidectomy in PHPT patients
背景/目的：持续性高钙血症会损害肾功能，而在晚期原发性甲状旁腺功能亢进症（PHPT）中，肾小球滤过率（GFR）降低是典型表现。目前，关于 PHPT 患者肾功能损害的预测因素的数据很少。因此，我们旨在评估甲状旁腺切除术（PTX）后 PHPT 患者肾功能的变化，并确定这些患者 GFR 变化的相关因素。
本研究纳入了 2012 年至 2014 年间接受手术的 125 例 PHPT 患者。根据 GFR 值将患者分为两组：GFR 低于 60 mL/min/1.73 m2 和高于 60 mL/min/1.73 m2 的患者。比较了手术前后患者的人口统计学和实验室参数。
GFR 大于 60 与小于 60 mL/min/1.73 m2 的患者相比，降压药使用者、肾囊肿患者、甲状旁腺激素（PTH）和碱性磷酸酶水平更高（P < 0.05）。GFR 大于 60 的患者收缩压、尿酸和镁降低，但两组手术后 GFR 均无变化。手术后，两组血钙和 PTH 降低，25(OH)D3 和磷增加。在多元回归分析中，年龄、钙和基线 GFR 是 GFR 变化的独立预测因素。甲状旁腺腺瘤体积和尿钙不是 GFR 变化的独立预测因素。
年龄较大、术前血钙较高和 GFR 较高是 PHPT 患者手术后 GFR 增加的相关因素。甲状旁腺切除术可防止 PHPT 患者进一步的肾功能损害。
