Differences in metabolic urinary abnormalities in stone forming and nonstone forming patients with primary hyperparathyroidism (original) (raw)
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BMJ (online)
To study the risk of renal stone episodes and risk factors for renal stones in primary hyperparathyroidism before and after surgery. Register based, controlled retrospective follow up study. Tertiary hospitals in Denmark. 674 consecutive patients with surgically verified primary hyperparathyroidism. Each patient was compared with three age- and sex-matched controls randomly drawn from the background population. Hospital admissions for renal stone disease were compared between patients and controls. Risk factors for renal stones among patients were assessed. Number of renal stone episodes; comparison of hospital admissions for renal stones in patients and controls; assessment of risk factors for renal stones. Relative risk of a stone episode was 40 (95% confidence interval 31 to 53) before surgery and 16 (12 to 23) after surgery. Risk was increased 10 years before surgery, and became normal more than 10 years after surgery. Stone-free survival 20 years after surgery was 90.4% in pati...
The Journal of Clinical Endocrinology & Metabolism
Context Primary hyperparathyroidism (PHPT) is associated with an increased risk of kidney stones. Few studies account for PHPT severity or stone risk when comparing stone events after parathyroidectomy vs nonoperative management. Objective Compare the incidence of kidney stone events in PHPT patients treated with parathyroidectomy vs nonoperative management. Design Longitudinal cohort study with propensity score inverse probability weighting and multivariable Cox proportional hazards regression. Setting Veterans Health Administration integrated health care system. Patients A total of 44 978 patients with > 2 years follow-up after PHPT diagnosis (2000-2018); 5244 patients (11.7%) were treated with parathyroidectomy. Main outcomes measure Clinically significant kidney stone event. Results The cohort had a mean age of 66.0 years, was 87.8% male, and 66.4% White. Patients treated with parathyroidectomy had higher mean serum calcium (11.2 vs 10.8mg/dL) and were more likely to have a h...
BJU International, 2009
To compare the clinical presentation, laboratory features and outcome of treatment in stone formers (SF) with primary hyperparathyroidism (HPT) to those without systemic disease. We compared 105 (54 female) stone-formers (SF) with primary hyperparathyroidism (HPT) to 2416 (835 female) common SF with no systemic disease, and 260 normal subjects (NS, 106 female) using pre-treatment and treatment data from our kidney-stone programme. All were assessed before treatment, with three 24-h urine samples, for stone risk factors, each with a corresponding fasting blood sample. Records were reviewed for stone rates and urological stone-related procedures. The hypercalcaemia of HPT was modest, but hypercalciuria was far more marked than in SF because the fractional calcium excretion of HPT exceeded that of SF. Surgical cure of HPT did not completely eradicate either hypercalciuria or hypophosphataemia, suggesting that these patients have some additional mineral disorder. Serum calcium and phosphate, and fractional excretion of calcium, combined into a discriminant function provided the best separation between HPT and SF. However, we present 49 patients for whom the diagnosis (HPT vs SF) has never been resolved, despite years of observation and successful reduction of stone recurrence. Stones in HPT have slightly more phosphate than SF but the difference is not large enough to be of clinical interest. The stone frequency in HPT is about that for SF, and treatment reduces stones in HPT and SF by about the same amount, 10 times. No study to date has compared HPT with SF and NS, as done here. SF with even slight hypercalcaemia and brisk hypercalciuria probably have this curable disease, and after cure clinicians must be wary of residual hypercalciuria that requires medical treatment. Some patients will never be fully diagnosed and remain, like ours, an enigma, albeit responsive to usual medical treatments. Although stones are modestly enriched with phosphate, most are mainly calcium oxalate, so the stone analysis is not clinically a guide to diagnosis.
The Most Important Metabolic Risk Factors in Recurrent Urinary Stone Formers
Urology …, 2011
To evaluate different urinary factors contributing to idiopathic calcium stone disease for determining appropriate medical treatments. Materials and Methods: Two 24-hour urine samples were collected from 106 male recurrent idiopathic calcium stone formers and another 109 randomly selected men as the control group matching for age. Results: Cases had significantly higher mean urine oxalate, calcium, uric acid, and chloride in comparison with the healthy controls (P < .001). After necessary adjustment, only mean urine levels of oxalate and uric acid were higher in stone formers than those in controls. The mean value of supersaturation for calcium oxalate was significantly higher in patients than the controls (P = .001); whereas supersaturation for calcium phosphate and uric acid did not reach statistical significe (P = .675 and P = .675, respectively). Hyperoxaluria and hypercalciuria were among the most frequent abnormalities. After categorizing urine parameter values into four quartiles, the risk of stone formation was found to increase as the urine calcium, oxalate, uric acid, chloride, and citrate rise. In contrast, the risk of stone formation decreased with the increase of urine potassium. Conclusion: Oxalate seems to play the most important role as urinary stone risk factor in our population followed by calcium and uric acid. In addition to the risk factors, it seems that supersaturation as the sum of all risk factors probably has a high predictive value.
Timely Evaluation and Management of Primary Hyperparathyroidism in Patients With Kidney Stones
The Journal of surgical research, 2018
Nephrolithiasis is a classic, treatable manifestation of primary hyperparathyroidism (PHPT). We examined predictors of kidney stone formation in PHPT patients and determined how efficiently the diagnosis of PHPT is made in patients whose initial presentation is with stones. We performed a retrospective analysis of surgically treated PHPT patients, comparing 247 patients who were kidney stone formers and 1047 patients with no kidney stones. We also analyzed 51 stone-forming patients whose stone evaluation and treatment were completed within our health system before PHPT diagnosis. Stone-forming patients had higher 24-h urinary calcium (342 versus 304 mg/d, P = 0.005), higher alkaline phosphatase (92 versus 85 IU/L, P = 0.012), and were more likely to be normocalcemic (26.6% versus 16.9%, P = 0.001). Surprisingly, 47.3% of stone formers had normal urinary calcium levels (<300 mg/d). Of the 51 stone-forming patients treated at our institution, serum calcium was measured within 6 mo ...
Urological Science, 2016
Purpose: Urinary stones are heterogenous but often grouped together. The incidence of CaP abundant (S50%) stone and Brushite stone has increased during the past 45 years in Taiwan. We reported here clinical finding and the potential effects of patient demographics on stone composition. Our purpose was to inform urologists and highlight area that seem to deserve further research. Materials and Methods: The first stone submitted by patients for analysis to the National Taiwan University Hospital (NTUH, 1961e2010) and National Cheng-Kung University Hospital (NCKUH, 2010e2016) were studied. Totally, 13672 stone analysis were examined at NTUH and 1061 at NCKUH, respectively. Stone were classified in the following order: majority calcium oxalate (S50%), majority (S50%) hydroxyapatite, any brushite, any metabolic stone (including uric acid and cysteine), and any struvite. Results: Though the most common stone component is CaOx, but its incidence decreased from 82.1% (1991e2000) to 53.3% (2010e2016). The incidence of CaP (Ca3(PO4)2) increased from 7.1% (2001e2010) to 27.9% (2010e2016), while brushite increased from 0.2% (1961e1980) to 1.8% (2010e2016). Mean age for patients with CaP stone is 56 ± 16 Y/O and male: female ratio ¼ 1.7:1; whereas mean age is 48 ± 18 Y/O and male: female ration is 3.7:1 for brushite stone patients. Patient with CaP abundant stone has a larger stone size (747.5±135.8mm^2) and lower eGFR (65.4 ± 18.9 mL/min/ 1.73m2) than patients with CaOx stone (73.7 ± 66.4 mm^2, and 85.9 ± 31.8 mL/min/1.73m2, respectively). Patient with CaP stone has a lower stone free rate and received more surgical procedures than CaOx stone disease (35.9% vs. 64%; 1.24 vs. 0.92, respectively). Patient with CaP stones has normal 24h urine Ca and uric acid and lower 24h urine Mg than CaOx stones. Conclusion: CaP has risen for recent four decades. Gender of CaP stone did not differ in this cohort, but they had decreased eGFR and larger stone size and received more procedures than CaOx. High urine pH (6.8) and low 24h urine Mg was the main metabolic abnormality.
2011
Purpose: To evaluate different urinary factors contributing to idiopathic calcium stone disease for determining appropriate medical treatments. Materials and Methods: Two 24-hour urine samples were collected from 106 male recurrent idiopathic calcium stone formers and another 109 randomly selected men as the control group matching for age. Results: Cases had significantly higher mean urine oxalate, calcium, uric acid, and chloride in comparison with the healthy controls (P < .001). After necessary adjustment, only mean urine levels of oxalate and uric acid were higher in stone formers than those in controls. The mean value of supersaturation for calcium oxalate was significantly higher in patients than the controls (P = .001); whereas supersaturation for calcium phosphate and uric acid did not reach statistical significe (P = .675 and P = .675, respectively). Hyperoxaluria and hypercalciuria were among the most frequent abnormalities. After categorizing urine parameter values int...
Persistence of hypercalciuria after successful surgical treatment for primary hyperparathyroidism
International urology and nephrology, 2012
Primary hyperparathyroidism (PHPT) causes hypercalciuria and stone disease in a subset of patients. Hypercalciuria typically normalizes after surgery, although the risk of stone formation may persist up to 10 years. There are few reports in the literature that show persistent hypercalciuria despite normalization of serum calcium after parathyroid surgery. We retrospectively analyzed 111 patients with PHPT from the osteoporosis, and stone clinics seen between 1999 and 2006. We selected only patients who had a complete metabolic profile that included 24-hour collections before and at least 3 months after parathyroidectomy. We excluded patients who had creatinine clearance \60 ml/min/ 1.73 m 2 . Fifty-four patients were selected for further analysis, 46 with baseline hypercalciuria and 8 with normocalciuria. Changes in filtered load of calcium and fractional excretion of calcium were evaluated before and after parathyroid surgery. Total and ionized calcium and phosphorus normalized in all patients after surgery (24 ± 19 months); fractional excretion of calcium decreased, but did not normalize. Hypercalciuria persisted after surgery in 30.7% (n = 12/39) of the women and 50% (n = 4/8) of men. Of the patients in whom calciuria normalized after parathyroidectomy, 43.3% (n = 13/30) had kidney stones before surgery, whereas kidney stones were present in 87.5% (n = 14/16) in those in whom hypercalciuria persisted postsurgery. In hypercalciuric men and women before surgery in whom hypercalciuria persisted after surgery, fractional excretion of calcium was significantly higher than that in patients with normocalciuria. Conclusions: Persistently increased fractional excretion of calcium could explain the sustained increased risk of stone disease in patients with PHPT for many years after successful parathyroidectomy.
Metabolic Evaluation of Stone Disease Patients: A Practical Approach
Journal of Endourology, 1999
In the last three decades, minimally invasive techniques have progressed significantly, replacing traditional open surgery as the mainstay of stone disease surgical treatment. The challenge for the next millennium remains medical prevention of calcium urolithiasis, a field where less dramatic progress has been achieved during the same period of time. The purpose of this article is to provide the practicing urologist with current practical guidelines for the assessment and management of calcium urolithiasis patients. The recommendations are based on the latest available information regarding the pathogenesis, medical treatment options, and decision-making rationale when managing these challenging patients. Every urolithiasis patient should undergo a basic evaluation, which is considered the minimal essential diagnostic work-up, in order to rule out obvious, treatable systemic causes of urinary stone disease. All patients should be advised about conservative nonspecific preventive measures. High-risk stone patients should have a more extensive metabolic evaluation based on two 24-hour urine samples. Treatment protocols for each patient are tailored individually according to the metabolic evaluation findings.