Service d'Explorations Fonctionnelles Multidisciplinaires, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France.
Université Pierre et Marie Curie Univ Paris 06, INSERM, UMR-S 1155, Paris, France.
Urolithiasis. 2021 Aug;49(4):327-334. doi: 10.1007/s00240-020-01239-x. Epub 2021 Jan 9.
Parathyroidectomy (PTX) is routinely performed in hypercalciuric renal stone patients with primary hyperparathyroidism (PHPT). However, some data indicate a persistent stone activity following PTX, raising the issue of the link between PHPT and stone disease. We performed an observational study on 30 renal stone patients diagnosed with PHPT. Patients were selected among 1448 hypercalciuric patients referred in our department for a diagnostic evaluation. Patients with no parathyroid surgery or any biological follow-up were excluded. Clinical and biological data (including 24-h urine collection and a calcium load test) were collected before and within 12 months following surgery. Stone recurrence was evaluated by direct phone contact (median 43 months). Comparison of biological data before and after surgery showed a significant decrease of ionized calcium and serum parathyroid hormone after PTX. All stones contained calcium-dependent species such as carbapatite, brushite or dihydrate calcium oxalate. Urine saturation indexes and calciuria significantly decreased after surgery (from 9.9 to 5.9 mmol/d, p < 0.0001), but a persistent hypercalciuria was detected in 47% of patients. The other stone risk factors including diuresis stayed similar. Stone activity that was increasing (from 0.20-0.30 to 0.50-0.75/year) the 2 years before PTX, significantly decreased after surgery [0.05-0.15/year (p < 0.001)]. PTX in calcium-dependent renal stone formers with PHPT significantly decreases both stone recurrence and urine saturation indexes. However, PTX unmasked an underlying renal stone disease related to idiopathic hypercalciuria in half of patients with a remaining stone activity, testifying the need for patient's follow-up to prevent stone recurrence.
甲状旁腺切除术 (PTX) 通常用于原发性甲状旁腺功能亢进症 (PHPT) 伴高钙尿症肾结石患者。然而，一些数据表明 PTX 后结石活动持续存在，这引发了 PHPT 与结石病之间关系的问题。我们对 30 例被诊断为 PHPT 的肾结石患者进行了一项观察性研究。这些患者是从我们科室接受诊断评估的 1448 例高钙尿症患者中选择的。排除了无甲状旁腺手术或任何生物学随访的患者。收集了手术前后的临床和生物学数据（包括 24 小时尿液收集和钙负荷试验）。通过直接电话联系评估结石复发（中位时间为 43 个月）。手术前后生物学数据的比较显示，PTX 后离子钙和血清甲状旁腺激素显著下降。所有结石均含有钙依赖性物质，如碳磷灰石、二水草酸钙或一水合草酸钙。手术后尿饱和度指数和钙排量明显下降（从 9.9 降至 5.9mmol/d，p<0.0001），但 47%的患者仍存在高钙尿症。其他结石危险因素，包括利尿作用，保持相似。PTX 前 2 年结石活动增加（从 0.20-0.30 增至 0.50-0.75/年），手术后显著减少[0.05-0.15/年（p<0.001）]。甲状旁腺切除术显著降低了 PHPT 伴钙依赖性肾结石形成者的结石复发率和尿饱和度指数。然而，PTX 揭示了一半患者的潜在肾结石与特发性高钙尿症有关，这表明需要对患者进行随访以预防结石复发。
