Maschio G, Tessitore N, D'Angelo A, Fabris A, Corgnati A, Oldrizzi L, Loschiavo C, Lupo A, Valvo E, Gammaro L, Rugiu C
Am J Nephrol. 1982;2(2):77-84. doi: 10.1159/000166588.
28 adult patients with radiological evidence of medullary sponge kidney (MSK) were studied. Hypercalcemia and increased serum parathyroid hormone (PTH) values were found in 10 patients (36%). In 7 of them, parathyroid surgery was performed: a single adenoma was found in 6 cases and multiple-gland hyperplasia in 1 case. After surgery, 3 patients had normalization of calcium metabolism; 4 patients had persistence of hypercalciuria with progressive increase in serum PTH values (and recurrence of the adenoma in 1 case). Of the remaining patients, 10 (36%) had definite or marginal hypercalciuria, resulting from renal calcium leak in 8 and from intestinal calcium hyperabsorption in 2 of them. In 8 patients (28%), no evidence of disordered calcium metabolism was found. The association of MSK and hyperparathyroidism is not a chance occurrence. MSK might be a renal anatomical complication of primary hyperparathyroidism, or it might be regarded as an anatomic substrate--or rather as a consequence--of prolonged hypercalciuria, regardless of its pathogenesis. The lack of disordered calcium metabolism in a considerable number of patients, however, shows that the enigma of MSK is still far from being solved.
对28例有髓质海绵肾（MSK）影像学证据的成年患者进行了研究。10例患者（36%）发现有高钙血症和血清甲状旁腺激素（PTH）值升高。其中7例患者接受了甲状旁腺手术：6例发现单个腺瘤，1例发现多腺体增生。术后，3例患者钙代谢恢复正常；4例患者持续存在高钙尿症，血清PTH值逐渐升高（1例腺瘤复发）。其余患者中，10例（36%）有明确或临界高钙尿症，其中8例是由肾钙泄漏引起，2例是由肠道钙吸收过多引起。8例患者（28%）未发现钙代谢紊乱的证据。MSK与甲状旁腺功能亢进的关联并非偶然。MSK可能是原发性甲状旁腺功能亢进的一种肾脏解剖学并发症，或者它可能被视为长期高钙尿症的一种解剖学基础——或者更确切地说是一种后果——无论其发病机制如何。然而，相当数量患者不存在钙代谢紊乱，这表明MSK之谜仍远未解决。
