Yalçın Nazif, Ertınmaz Özkan Ayşegül, Güneş Elif, Koca Nizameddin
Department of Internal Medicine, Bursa Sehir Training and Research Hospital, University of Health Sciences, Bursa, Turkey.
Department of Endocrinology and Metabolism, Bursa Sehir Training and Research Hospital, University of Health Sciences, Bursa, Turkey.
Sci Rep. 2025 Jan 28;15(1):3545. doi: 10.1038/s41598-025-86954-4.
Primary hyperparathyroidism (pHPT) is marked by mineral imbalances, often leading to nephrolithiasis and osteoporosis. While imaging remains the cornerstone for stone detection, there is growing interest in biochemical markers that could enhance diagnostic accuracy. This study investigates the calcium-to-magnesium (Ca/Mg) ratio as a novel biomarker for nephrolithiasis, comparing its utility to traditional 24-h urinary calcium excretion and exploring its broader clinical implications. In this retrospective study of 367 pHPT patients, clinical, biochemical, and bone mineral density (BMD) data were analyzed. Nephrolithiasis was diagnosed via imaging, and the diagnostic performance of the Ca/Mg ratio and urinary calcium excretion was assessed through receiver operating characteristic analysis. Multivariable regression was employed to identify predictors of kidney stones. The Ca/Mg ratio, with an optimal cutoff of 6.35, demonstrated superior specificity (78%) compared to 24-h urinary calcium excretion (44%) while maintaining comparable sensitivity (71% vs. 78%). Elevated Ca/Mg ratios strongly correlated with nephrolithiasis, independent of other demographic factors. Hypomagnesemia was linked to a higher prevalence of kidney stones, reduced BMD, and increased serum calcium and creatinine levels, emphasizing its impact on skeletal and renal health. The Ca/Mg ratio emerges as a promising, non-invasive biomarker for nephrolithiasis in pHPT, outperforming traditional urinary calcium measures. It reflects underlying mineral imbalances and offers a practical tool for risk stratification and clinical decision-making. These findings underscore the need for further research into magnesium-targeted interventions, which may transform the management of pHPT-related complications.
原发性甲状旁腺功能亢进症（pHPT）的特征是矿物质失衡，常导致肾结石和骨质疏松症。虽然影像学检查仍然是结石检测的基石，但人们对能够提高诊断准确性的生化标志物的兴趣与日俱增。本研究调查钙镁比（Ca/Mg）作为一种用于肾结石的新型生物标志物，将其效用与传统的24小时尿钙排泄进行比较，并探讨其更广泛的临床意义。在这项对367例pHPT患者的回顾性研究中，分析了临床、生化和骨矿物质密度（BMD）数据。通过影像学检查诊断肾结石，并通过受试者操作特征分析评估Ca/Mg比和尿钙排泄的诊断性能。采用多变量回归来确定肾结石的预测因素。Ca/Mg比的最佳临界值为6.35，与24小时尿钙排泄（44%）相比，显示出更高的特异性（78%），同时保持了相当的敏感性（71%对78%）。Ca/Mg比升高与肾结石密切相关，独立于其他人口统计学因素。低镁血症与肾结石的较高患病率、BMD降低以及血清钙和肌酐水平升高有关，强调了其对骨骼和肾脏健康的影响。Ca/Mg比成为pHPT中一种有前景的、非侵入性的肾结石生物标志物，优于传统的尿钙测量方法。它反映了潜在的矿物质失衡，并为风险分层和临床决策提供了一种实用工具。这些发现强调了对以镁为靶点的干预措施进行进一步研究的必要性，这可能会改变pHPT相关并发症的管理方式。
