Nephrocalcinosis, Renal Dysfunction, and Calculi in Patients With Primary Hypoparathyroidism on Long-Term Conventional Therapy
- 1 April 2020
- journal article
- research article
- Published by The Endocrine Society in Journal of Clinical Endocrinology & Metabolism
- Vol. 105 (4), e1215-e1224
- https://doi.org/10.1210/clinem/dgz319
Abstract
Context: There are concerns about the long-term safety of conventional therapy on renal health in patients with hypoparathyroidism. Careful audit of these would help comparisons with upcoming parathyroid hormone therapy. Objective: We investigated nephrocalcinosis, renal dysfunction, and calculi, their predictors and progression over long-term follow-up in patients with primary hypoparathyroidism (PH). Design and Setting: An observational study at a tertiary care center was conducted. Participants and Methods: A total of 165 PH patients receiving conventional therapy were evaluated by radiographs, ultrasonography, and computed tomography. Their glomerular filtration rate (GFR) was measured by Tc-99m-diethylenetriamine penta-acetic acid clearance. Clinical characteristics, serum total calcium, phosphorus, creatinine, hypercalciuria, and fractional excretion of phosphorus (FEPh) at presentation and during follow-up were analyzed as possible predictors of renal complications. Controls were 165 apparently healthy individuals. Results: Nephrocalcinosis was present in 6.7% of PH patients but not in controls. Patients younger than 15 years at presentation and with higher serum calcium-phosphorus product were at higher risk. Nephrocalcinosis showed no significant association with cataract and intracranial calcification. Prevalence of renal calculi was comparable between hypoparathyroid patients and controls (5% vs 3.6%, P = .58). Fourteen percent of patients had a GFR less than 60 mL/min/1.73 m(2). Increased FEPh during follow-up was the significant predictor of low GFR. Nephrocalcinosis developed in 9% of patients over 10 years of conventional therapy. Conclusion: A total of 6.7% of PH patients had nephrocalcinosis, and 14% showed renal dysfunction. Prevalence of renal calculi was similar in patients and controls. Nine percent of patients developed nephrocalcinosis over 10 years of conventional therapy.Funding Information
- Department of Biotechnology, Ministry of Science and Technology, Government of India (BT/PR22675/MED/30/1806/2016)
This publication has 32 references indexed in Scilit:
- Cardiovascular and renal complications to postsurgical hypoparathyroidism: A Danish nationwide controlled historic follow-up studyJournal of Bone and Mineral Research, 2013
- Prevalence and progression of basal ganglia calcification and its pathogenic mechanism in patients with idiopathic hypoparathyroidismClinical Endocrinology, 2012
- Phenotypic Variation in a Large Family with Autosomal Dominant HypocalcaemiaHormone Research in Paediatrics, 2010
- Presence and significance of a R110W mutation in the DNA-binding domain of GCM2 gene in patients with isolated hypoparathyroidism and their family membersActa Endocrinologica, 2010
- Dynamic and Structural Properties of the Skeleton in HypoparathyroidismJournal of Bone and Mineral Research, 2008
- HypoparathyroidismThe New England Journal of Medicine, 2008
- Pattern of bone mineral density in patients with sporadic idiopathic hypoparathyroidismClinical Endocrinology, 2006
- Nephrocalcinosis: molecular insights into calcium precipitation within the kidneyClinical Science, 2004
- Medullary nephrocalcinosis associated with long‐term furosemide abuse in adultsNephrology Dialysis Transplantation, 2001
- A Familial Syndrome of Hypocalcemia with Hypercalciuria Due to Mutations in the Calcium-Sensing ReceptorThe New England Journal of Medicine, 1996