Predictors of Renal Function and Calcifications in Primary Hyperparathyroidism: A Nested Case-Control Study

Ejlsmark-Svensson, Henriette; Bislev, Lise Sofie; Rolighed, Lars; Sikjær, Tanja; Rejnmark, Lars

doi:10.1210/jc.2018-00923

Cited by 31 publications

(37 citation statements)

References 44 publications

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“…8 Interestingly, predictors of renal dysfunction described by Walker et al 8 (namely age and hypertension) were not found to be associated with urinary KIM-1 excretion in our cohort. In accordance with recent data by Ejlsmark-Svensson et al, 7 factors related with severity of the disease were instead associated with the urine KIM-1/uCr ratio. Notwithstanding the differences in the populations studied, these findings seem to indicate that urine KIM-1/uCr ratio could be considered not only a sensitive but also a specific marker of renal damage during PHPT.…”

Section: Discussionmentioning

confidence: 99%

“…With reference to the renal involvement, patients with PHPT may present nephrolithiasis (the most common complication of the disease), nephrocalcinosis, hypercalciuria and chronic kidney disease (CKD) . In particular, an estimated glomerular filtration rate (GFR) <60 mL/min is reported in a figure of 12%‐19% depending on series and this value represents the threshold under whom parathyroidectomy is recommended . The pathophysiology of CKD in PHPT is not completely understood.…”

Section: Introductionmentioning

confidence: 99%

“…3 In particular, an estimated glomerular filtration rate (GFR) <60 mL/min is reported in a figure of 12%-19% depending on series and this value represents the threshold under whom parathyroidectomy is recommended. 6,7 The pathophysiology of CKD in PHPT is not completely understood. The presence of nephrolithiasis or nephrocalcinosis, as well as indices associated with severity of the disease, was not found to be predictors of kidney dysfunction in patients with PHPT.…”

Section: Introductionmentioning

confidence: 99%

“…The presence of nephrolithiasis or nephrocalcinosis, as well as indices associated with severity of the disease, was not found to be predictors of kidney dysfunction in patients with PHPT. 7,8 Walker et al 8 have reported that traditional risk factors for CKD, as age and diastolic blood pressure, are rather associated with altered renal function in a cohort of 114 patients with mild PHPT.…”

Section: Introductionmentioning

confidence: 99%

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Investigating subtle kidney injury in primary hyperparathyroidism by means of sensitive and specific biomarkers

Cipriani

Pepe

Colangelo

et al. 2019

Clinical Endocrinology

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Objective Kidney involvement is a common complication in primary hyperparathyroidism (PHPT). No study so far has assessed the prevalence of kidney injury developing before the reduction in glomerular filtration rate (GFR) in PHPT. The study was aimed at establishing the potential role of biomarkers of kidney injury in detecting subtle renal damage in patients with PHPT. Design Cross‐sectional study. Patients A total of 69 postmenopausal patients with PHPT and 41 healthy age‐ and sex‐matched subjects were studied. Exclusion criteria were as follows: GFR < 30 mL/min, chronic inflammatory disease, nephrotic syndrome, infection, malignancy, heart failure, recent exposure to iodinated contrast media or nonsteroidal anti‐inflammatory drugs. Measurements We measured a panel of sensitive biomarkers of kidney injury in PHPT vs controls. Results Mean FGF23 and Klotho were higher in PHPT (72 ± 48 and 811 ± 366 pg/mL, respectively) than controls (53 ± 23.5 and 668.6 ± 17; P < .02 and P < .05). Urine KIM‐1/uCr was significantly higher in PHPT (1.4−6 ± 1.3−6) than controls (9.2−7 ± 7−7; P < .05); this was particularly evident in the CrCl 60‐89 mL/min category (1.36 ± 97 vs 8.2−7 ± 3.6−7; P < .02). Mean values of urine NGAL/uCr were higher in PHPT with (n = 28) compared to those without kidney stones (n = 35; 1.8−5 ± 1.4−5 and 1−5 ± 8−6; P < .0001). We found significant positive associations between urine NGAL/uCr and Ca (R = .292, P < .02) and urine KIM1/uCr and PTH (R = .329, P < .01). Conclusions We propose the utilization of these molecules, particularly urine KIM‐1/uCr and urine NGAL/uCr ratios for the assessment of subtle kidney injury in patients with PHPT. These molecules are elevated in tubular necrosis and have potential role in the development of kidney damage in PHPT, according to the severity of the disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Investigating subtle kidney injury in primary hyperparathyroidism by means of sensitive and specific biomarkers

Cipriani

Pepe

Colangelo

et al. 2019

Clinical Endocrinology

View full text Add to dashboard Cite

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“…In the recent Danish study, the overall prevalence of vertebral fractures was around 22% for all age groups, and of interest higher in men compared with women in younger patients less than 60 years. Most of the fractures were mild to moderate and only 28.7% had severe fractures by the method of Genant (111, 112). When compared to patients with postmenopausal osteoporosis, patients with PHPT seemed to fracture at a higher BMD level (112).…”

Section: Primary Hyperparathyroidismmentioning

confidence: 99%

Unmet therapeutic, educational and scientific needs in parathyroid disorders: Consensus Statement from the first European Society of Endocrinology Workshop (PARAT)

Bollerslev

Schalin‐Jäntti

Rejnmark

et al. 2019

European Journal of Endocrinology

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PARAT, a new European Society of Endocrinology program, aims to identify unmet scientific and educational needs of parathyroid disorders, such as primary hyperparathyroidism (PHPT), including parathyroid cancer (PC), and hypoparathyroidism (HypoPT). The discussions and consensus statements from the first PARAT workshop (September 2018) are reviewed. PHPT has a high prevalence in Western communities, yet evidence is sparse concerning the natural history and whether morbidity and long-term outcomes are related to hypercalcemia or plasma PTH concentrations or both. Cardiovascular mortality and prevalence of low energy fractures are increased, whereas quality of life is decreased, although their reversibility by treatment of PHPT has not been convincingly demonstrated. PC is a rare cause of PHPT, with increasing incidence, and international collaborative studies are required to advance knowledge of the genetic mechanisms, biomarkers for disease activity and optimal treatments. For example, ~20% of PCs demonstrate high mutational burden, and identifying targetable DNA variations, gene amplifications and gene fusions may facilitate personalized care, such as different forms of immunotherapy or targeted therapy. HypoPT, a designated orphan disease, is associated with a high risk of symptoms and complications. Most cases are secondary to neck surgery. However, there is a need to better understand the relation between disease biomarkers and intellectual function and to establish the role of PTH in target tissues, as these may facilitate the appropriate use of PTH substitution therapy. Management of parathyroid disorders is challenging, and PARAT has highlighted the need for international transdisciplinary scientific and educational studies in advancing in this field.

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Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop

Bilezikian

Khan

Silverberg

et al. 2020

Journal of Bone and Mineral Research

195

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The last international guidelines on the evaluation and management of primary hyperparathyroidism (PHPT) were published in 2014. Research since that time has led to new insights into epidemiology, pathophysiology, diagnosis, measurements, genetics, outcomes, presentations, new imaging modalities, target and other organ systems, pregnancy, evaluation, and management. Advances in all these areas are demonstrated by the reference list in which the majority of listings were published after the last set of guidelines. It was thus, timely to convene an international group of over 50 experts to review these advances in our knowledge. Four Task Forces considered: 1. Epidemiology, Pathophysiology, and Genetics; 2. Classical and Nonclassical Features; 3. Surgical Aspects; and 4. Management. For Task Force 4 on the Management of PHPT, Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology addressed surgical management of asymptomatic PHPT and non‐surgical medical management of PHPT. The findings of this systematic review that applied GRADE methods to randomized trials are published as part of this series. Task Force 4 also reviewed a much larger body of new knowledge from observations studies that did not specifically fit the criteria of GRADE methodology. The full reports of these 4 Task Forces immediately follow this summary statement. Distilling the essence of all deliberations of all Task Force reports and Methodological reviews, we offer, in this summary statement, evidence‐based recommendations and guidelines for the evaluation and management of PHPT. Different from the conclusions of the last workshop, these deliberations have led to revisions of renal guidelines and more evidence for the other recommendations. The accompanying papers present an in‐depth discussion of topics summarized in this report. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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Predictors of Renal Function and Calcifications in Primary Hyperparathyroidism: A Nested Case-Control Study

Abstract: Renal calcifications are frequent in patients with PHPT and are associated with the severity of the disease. Impaired renal function is also common in PHPT, but renal function was not associated with renal calcifications.

Cited by 31 publications

References 44 publications

Investigating subtle kidney injury in primary hyperparathyroidism by means of sensitive and specific biomarkers

Investigating subtle kidney injury in primary hyperparathyroidism by means of sensitive and specific biomarkers

Unmet therapeutic, educational and scientific needs in parathyroid disorders: Consensus Statement from the first European Society of Endocrinology Workshop (PARAT)

Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop

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