Nephrolithiasis and Renal Calcifications in Primary Hyperparathyroidism

Rejnmark, Lars; Vestergaard, Peter; Mosekilde, Leif

doi:10.1210/jc.2011-0569

Cited by 167 publications

(123 citation statements)

References 67 publications

(84 reference statements)

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“…In spite of increased renal reabsorption of calcium, hypercalciuria is produced from the excess calcium load. Thus, one may find hypercalciuria in all patients with untreated HPT, and place all patients at an increased risk of renal calculi (19,20). In the present study, there was a positive correlation between PTH levels and urinary calcium level which is in agreement with the previous studies (21).…”

Section: Discussionsupporting

confidence: 93%

Association between vitamin D, parathyroid hormone and inflammatory markers in urolithiasis patients

Venkatesan¹,

Chakkarai²,

Arulvijayavani³

et al. 2017

J Renal Inj Prev

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Implication for health policy/practice/research/medical education:As urolithiasis patients are at a constant inflammatory insult caused by the calculi, the levels of inflammatory markers can be used to monitor the success of treatment. Vitamin D and anti-inflammatory agents may be used in the management of nephrolithiasis patients. Please cite this paper as: Introduction:Hypercalciuria plays an important role in the pathogenesis of renal calculi. The role of vitamin D, parathyroid hormone (PTH), inflammatory markers highly sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in the development of renal calculi has not well defined. Objectives: To assess the serum levels of vitamin D, PTH, hs-CRP and IL-6, urinary and serum calcium and phosphorus levels in patients with renal calculi and to compare these parameters with healthy controls Patients and methods: It was a cross-sectional study. About 41 confirmed renal calculi patients and 41 age and sex matched controls were recruited. Patients with malignancies, hyperparathyroidism, chronic disease, and patients taking vitamin D supplementations were excluded. Serum levels of 25(OH) vitamin D, i-PTH, hs-CRP, IL-6, calcium and phosphorous, 24 hours urine levels of calcium and phosphorus were estimated Results: There was a statistical significant difference in the serum levels of 25(OH) vitamin D (12.26 vs 19.61 ng/mL), i-PTH (75.5 vs. 33.5 pg/mL), hsCRP (5117.05 vs. 1721.87 ng/mL), IL-6 (13.49 vs. 1.47 pg/mL) calcium (11.5 vs. 9.4 mg/dL) and urinary calcium (370.5 vs. 342 mg/d) and phosphorous levels (1172 vs. 1432 mg/d) between the cases and the control. There was negative correlation between the levels of i-PTH and vitamin D (r = -0.765) and positive correlation between i-PTH and hsCRP, IL-6, Serum calcium and urine calcium (r = 0.353, 0.340, 0.522, 0.501 respectively) Conclusion: There was vitamin D inadequacy and increased levels of PTH, IL-6 and C-reactive protein, calcium in patients with renal calculi when compared with healthy controls.

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Section: Discussionsupporting

confidence: 93%

Association between vitamin D, parathyroid hormone and inflammatory markers in urolithiasis patients

Venkatesan¹,

Chakkarai²,

Arulvijayavani³

et al. 2017

J Renal Inj Prev

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“…11,12 In addition, there are mixed results from studies that have tried to demonstrate that hypercalciuria itself promotes nephrolithiasis. 13 Given this information, the guidelines for the management of asymptomatic PHPT have recently changed. A 24-hour urine calcium is still recommended in the initial evaluation of suspected patients with PHPT, in order to differentiate it from FHH, but is no longer recommended as a criterion for parathyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

24-Hour Urinary Calcium in Primary Hyperparathyroidism

Black

Berg

Urquhart

2013

Clinical Medicine & Research

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Objective: To establish whether urinary and serum calcium levels are correlated in patients with primary hyperparathyroidism (PHPT) and to evaluate related factors including serum levels of parathyroid hormone (PTH) and vitamin D, age, gender and renal function. Design:Retrospective review on patients undergoing a parathyroidectomy for PHPT from 2000-2008. Data collected included: age, sex, preoperative serum calcium (ionized and total), creatinine, PTH, postoperative ionized calcium, vitamin D, and 24-hour urine calcium and creatinine. Data were evaluated by standard descriptive statistics. Results:Of the 214 patients evaluated, preoperative 24-hour urinary calcium was available for 150 patients (70%). 24-hour urine calcium levels did not correlate significantly with preoperative total serum or ionized calcium, PTH, vitamin D, or postoperative serum ionized calcium. There were significant correlations (P < 0.0001) of 24-hour urinary calcium with age, serum creatinine, and urine creatinine. Secondary analysis grouped subjects by urinary calcium level greater or less than 400 mg/24 hours. Age and urinary creatinine were significantly different between the two groups. Conclusions:In patients with PHPT who underwent parathyroidectomy, there was little correlation between preoperative 24-hour urine calcium and preoperative serum calcium, PTH, or vitamin D levels. 24-hour urine calcium levels were correlated with renal function and age, but these correlations are likely to occur in the general population and are not specific to this disease group. The normal physiology of calcium metabolism is complex and depends on many factors such as renal function, diet, and age. When this normal metabolism is disrupted, it can acutely lead to hypercalcemia, which causes an increase in urinary calcium excretion through mediation of the calcium sensing receptor (CaSR) in the kidney. Hypercalciuria has been used as a diagnostic marker and indicator for parathyroidectomy in patients with primary hyperparathyroidism (PHPT). Urinary calcium excretion as a function of serum calcium was demonstrated more than 50 years ago.1 However, it is not clear if 24-hour urine calcium levels correlate with preoperative total serum or ionized calcium, parathyroid hormone (PTH), and vitamin D in patients with primary hyperparathyroidism.The 24-hour urinary sample, in addition to serologic studies, has historically been part of the standard diagnostic evaluation for patients suspected of PHPT. The use of 24-hour urine studies in PHPT has served two primary functions: elevated urinary calcium was thought to be a risk factor for

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“…Several factors may promote precipitation of crystals: increased renal calcium excretion and increased urine phosphate, increased urine oxalate, increased urine sodium, decreased urine citrate concentrations and proteinuria. Hypercalciuria is the main risk factor for kidney stone development in PHPT patients (8). Evidence, not confirmed by other studies, also suggested that relative high urine oxalate excretion and low urine citrate levels contribute to kidney stone risk in PHPT patients (3), while the role of urine phosphate, magnesium, sodium and potassium has not been established (8).…”

Section: Kidney Stones In Phpt Patientsmentioning

confidence: 99%

“…Hypercalciuria is the main risk factor for kidney stone development in PHPT patients (8). Evidence, not confirmed by other studies, also suggested that relative high urine oxalate excretion and low urine citrate levels contribute to kidney stone risk in PHPT patients (3), while the role of urine phosphate, magnesium, sodium and potassium has not been established (8). Therefore, recent guidelines (9, 10) suggested determining the risk of kidney stones in PHPT patients with 24-h urine calcium >400 mg by evaluating the urinary stone risk profile.…”

Section: Kidney Stones In Phpt Patientsmentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: Kidney involvement in patients with primary hyperparathyroidism: an update on clinical and molecular aspects

Verdelli

Corbetta

2017

European Journal of Endocrinology

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Primary hyperparathyroidism (PHPT) is the third most common endocrine disease. Kidney is a target of both chronic elevated PTH and calcium in PHPT. The classic PHPT complications of symptomatic kidney stones and nephrocalcinosis have become rare and the PHPT current presentation is asymptomatic with uncertain and long-lasting progression. Nonetheless, the routine use of imaging and of biochemical determinations have revealed the frequent occurrence of asymptomatic kidney stones, hypercalciuria and reduced kidney function in asymptomatic PHPT patients. Though the pathogenesis is far from being elucidated, PHPT is associated with reduced renal function, in terms of estimated glomerular filtration rate, and related increased morbidity and mortality. In the last decade, the effort of the Kidney Disease: Improving Global Outcomes (KDIGO) panel of experts highlighted that even mild reduction of kidney function is associated with increased risk of cardiovascular disease. These considerations provided the basis for the Fourth Workshop recommendations of a more extensive diagnostic workout about kidney features and of wider criteria for parathyroid surgery including asymptomatic kidney disease. Moreover, kidney involvement in PHPT is likely to be affected by variants of genes coding the key molecules regulating the calcium and ions renal handling; these features might have clinical relevance and should be considered both during diagnostic workout and follow-up. Finally, the effects of parathyroid surgery and of medical treatment on kidney involvement of PHPT are reviewed.

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Nephrolithiasis and Renal Calcifications in Primary Hyperparathyroidism

Cited by 167 publications

References 67 publications

Association between vitamin D, parathyroid hormone and inflammatory markers in urolithiasis patients

Association between vitamin D, parathyroid hormone and inflammatory markers in urolithiasis patients

24-Hour Urinary Calcium in Primary Hyperparathyroidism

MECHANISMS IN ENDOCRINOLOGY: Kidney involvement in patients with primary hyperparathyroidism: an update on clinical and molecular aspects

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