¿Mejora la función renal tras la paratiroidectomía en el hiperparatirodismo primario? / Does renal function improve after parathyroidectomy in primary hyperparathyroidism?

Introducción: El hiperparatiroidismo primario (HPTP) es un trastorno endocrino frecuente, caracterizado por hipercalcemia y elevación de la parathormona. La disminución del filtrado glomerular ( < 60ml/min) se mantiene en la guías como un criterio para la realización de la paratiroidectomía (PTX) en el HPTP asintomático. La influencia que tiene la PTX sobre la evolución de la función renal es controvertida. Objetivos: Analizar las características clínicas, analíticas e histológicas de los pacientes intervenidos por HPTP, así como la evolución de la función renal tras la PTX. Material y métodos: Estudio retrospectivo de 297 pacientes con HPTP remitidos a cirugía en un único centro entre 1998 y 2016. Los parámetros analíticos se determinaron en situación basal, a la semana y al año de la PTX. Resultados: La incidencia de PTX fue de 38 casos/millón/año. La edad media fue 60 ± 14 años y el 80,5% de los pacientes eran mujeres. El 65,3% estaban asintomáticos. La nefrolitiasis fue el hallazgo clínico más frecuente (33%) seguido de la afectación ósea (29,5%). Las indicaciones de PTX fueron: síntomas clínicos (34,7%), hipercalcemia > 11,2 mg/dl (27%), litiasis renal (13%), baja masa ósea (12%), edad < 50 años (11%) y disminución del filtrado < 60 ml/min (2,3%). En el diagnóstico de localización el spect-MIBI presentó una sensibilidad del 92% y la ecografía cervical del 70%. El 94,3% de los casos de HPTP eran debidos a un adenoma paratiroideo. Tras la PTX se objetivó normalización de los parámetros relacionados con el HPTP. Objetivamos un incremento significativo de la creatinina sérica (0,81 vs. 0,85 mg/dl, p < 0,001) desde la primera semana del postoperatorio y que se mantiene al año. Cuando comparamos los pacientes según el filtrado glomerular basal, encontramos que el deterioro de la función renal solamente fue significativo en pacientes con filtrado glomerular > 60 ml/min (creatinina sérica basal 0,77 mg/dl vs. creatinina sérica al año 0,81 mg/dl, p < 0,001). Conclusiones: El HPTP cursó asintomático en la mayoría de los pacientes intervenidos. La hipercalcemia y la nefrolitiasis fueron las indicaciones más frecuentes de paratiroidectomía en los pacientes asintomáticos. El scan-MIBI fue el método de localización más útil. La curación quirúrgica del HPTP se sigue de un deterioro de la función renal, que se mantiene desde la primera semana de la cirugía

Introduction: Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterised by hypercalcaemia and parathormone increase. Decreased glomerular filtration rate ( < 60 ml/min) continues to be a parathyroidectomy (PTX) criterion in asymptomatic PHPT. The influence of PTX on renal function evolution is the subject of debate. Objective: To analyse the clinical, laboratory and histological characteristics of patients undergoing PHPT, as well as renal function evolution after PTX. Material and methods: Retrospective study of 297 patients diagnosed with PHPT and referred to surgery in a single centre between 1998 and 2016. Laboratory parameters were determined at baseline, one week and one year after PTX. Results: The Incidence of PTX was 38 cases/million/year. Mean age was 60 ± 14 years and 80.5% of the patients were female. Approximately 65.3% were asymptomatic. Nephrolithiasis was the most common clinical finding (33%), followed by bone involvement (29.5%). PTX indications were: clinical symptoms (34.7%), hypercalcaemia > 11.2 mg/dl (27%), nephrolithiasis (13%), low bone mass (12%), age < 50 years (11%) and decreased glomerular filtration rate < 60 ml/min (2.3%). For diagnostic localisation, spect-MIBI had a sensitivity of 92% and cervical ultrasound of 70%. A total of 94.3% of PHPT cases were due to a parathyroid adenoma. After PTX, normalisation of PHPT-related parameters was observed. We found a significant increase in serum creatinine levels (0.81 vs 0.85 mg/dl, P < .001) from the first week post-PTX until the end of the first year. The renal function was only found to be significant in patients with glomerular filtration rate>60ml/min (baseline serum creatinine levels 0.77 mg/dl vs serum creatinine levels after one year 0.81 mg/dl, P < .001). Conclusions: PHPT was asymptomatic in most patients who underwent surgery. Hypercalcaemia and nephrolithiasis were the most common indications of parathyroidectomy in asymptomatic patients. MIBI scan was the most useful localisation method. Surgical treatment of PHPT is followed by renal function impairment, which persists after the first week post-PTX

Does renal function improve after parathyroidectomy in primary hyperparathyroidism? / ¿Mejora la función renal tras la paratiroidectomía en el hiperparatirodismo primario?

INTRODUCTION: Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterised by hypercalcaemia and parathormone increase. Decreased glomerular filtration rate (<60ml/min) continues to be a parathyroidectomy (PTX) criterion in asymptomatic PHPT. The influence of PTX on renal function evolution is the subject of debate. OBJECTIVE: To analyse the clinical, laboratory and histological characteristics of patients undergoing PHPT, as well as renal function evolution after PTX. MATERIAL AND METHODS: Retrospective study of 297 patients diagnosed with PHPT and referred to surgery in a single centre between 1998 and 2016. Laboratory parameters were determined at baseline, one week and one year after PTX. RESULTS: The Incidence of PTX was 38 cases/million/year. Mean age was 60±14 years and 80.5% of the patients were female. Approximately 65.3% were asymptomatic. Nephrolithiasis was the most common clinical finding (33%), followed by bone involvement (29.5%). PTX indications were: clinical symptoms (34.7%), hypercalcaemia>11.2mg/dl (27%), nephrolithiasis (13%), low bone mass (12%), age<50 years (11%) and decreased glomerular filtration rate<60ml/min (2.3%). For diagnostic localisation, spect-MIBI had a sensitivity of 92% and cervical ultrasound of 70%. A total of 94.3% of PHPT cases were due to a parathyroid adenoma. After PTX, normalisation of PHPT-related parameters was observed. We found a significant increase in serum creatinine levels (0.81 vs 0.85mg/dl, P<.001) from the first week post-PTX until the end of the first year. The renal function was only found to be significant in patients with glomerular filtration rate>60ml/min (baseline serum creatinine levels 0.77mg/dl vs serum creatinine levels after one year 0.81mg/dl, P<.001). CONCLUSIONS: PHPT was asymptomatic in most patients who underwent surgery. Hypercalcaemia and nephrolithiasis were the most common indications of parathyroidectomy in asymptomatic patients. MIBI scan was the most useful localisation method. Surgical treatment of PHPT is followed by renal function impairment, which persists after the first week post-PTX.

Nefropatía "oculta" tras preparaciones orales de fósforo para colonoscopia / "Hidden" nephropathy after oral phosphate preparation to colonoscopy

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Necesidad de estudio genético para el diagnóstico de algunos casos de acidosis tubular renal distal / The need for genetic study to diagnose some cases of distal renal tubular acidosis

Describimos el caso de una mujer joven, que fue diagnosticada de insuficiencia renal avanzada, con un hallazgo casual de una nefrocalcinosis sin una etiología clara, al haberse encontrado asintomática a lo largo de su vida. El estudio genético por paneles de genes conocidos asociados a enfermedad tubulointersticial permitió descubrir una acidosis tubular renal distal autosómica dominante, asociada a una mutación de novo en el exón 14 del gen SLC4A1, que hubiera sido imposible diagnosticar clínicamente por lo avanzado de la enfermedad renal cuando fue descubierta (AU)

We describe the case of a young woman who was diagnosed with advanced kidney disease, with an incidental finding of nephrocalcinosis of unknown aetiology, having been found asymptomatic throughout her life. The genetic study by panels of known genes associated with tubulointerstitial disease allowed us to discover autosomal dominant distal renal tubular acidosis associated with a de novo mutation in exon 14 of the SLC4A1 gene, which would have been impossible to diagnose clinically due to the advanced nature of the kidney disease when it was discovered (AU)

The need for genetic study to diagnose some cases of distal renal tubular acidosis. / Necesidad de estudio genético para el diagnóstico de algunos casos de acidosis tubular renal distal.

We describe the case of a young woman who was diagnosed with advanced kidney disease, with an incidental finding of nephrocalcinosis of unknown aetiology, having been found asymptomatic throughout her life. The genetic study by panels of known genes associated with tubulointerstitial disease allowed us to discover autosomal dominant distal renal tubular acidosis associated with a de novo mutation in exon 14 of the SLC4A1 gene, which would have been impossible to diagnose clinically due to the advanced nature of the kidney disease when it was discovered.