Renal Manifestations of Primary Hyperparathyroidism (PHPT)

  • Patients with PHPT have some degree of renal dysfunction or symptoms:
    • In approximately 80% of the cases of PHPT
  • The renal manifestations implicated with PHPT are:
    • Decreased glomerular filtration rate
    • Hypercalciuria
    • Nephrolithiasis
    • Nephrocalcinosis
    • Impaired urinary concentrating ability:
      • Sometimes leading to:
        • Polyuria
        • Polydipsia
        • Nocturia
    • Reduced fractional phosphate reabsorption:
      • Leading to hypophosphatemia
    • Increased urinary exertion of magnesium
  • Nephrolithiasis:
    • Was previously reported in approximately 40% to 80% of patients:
      • But now occur only in about 20% to 25% of the cases
    • The pathophysiology is thought to be related to:
      • The filtered load of calcium in the glomerulus:
        • That increases proportionately with the degree of hypercalcemia
    • Most renal stones in patients with PHPT:
      • Are composed of calcium oxalate:
        • Although slightly alkaline urine:
          • May favor the precipitation of calcium phosphate stones
    • Stone formers are more likely to be hypercalciuric:
      • But less than one-third of the hypercalciuric patients with PHPT:
        • Actually develop renal stones
    • Hypercalciuria:
      • Is not a predictor of nephrolithiasis in patients with PHPT:
        • Is no longer considered as an indication for surgery
  • Nephrocalcinosis:
    • Which refers to renal parenchymal calcification:
      • Is found in less than five percent of patients:
        • Is more likely to lead to renal dysfunction
  • The incidence of hypertension is variable;
    • Anywhere between 30% to 50% of patients with PHPT
  • Hypertension:
    • Appears to be more common in older patients
    • Correlates with the magnitude of renal dysfunction
    • In contrast to other symptoms:
      • Is least likely to improve after parathyroidectomy
  • Another plausible explanation of the origin of hypertension in patients with PHPT:
    • Is the synthesis of parathyroid hypertensive factor:
      • That triggers an increase in blood pressure
  • The elevated levels of PTH is also linked with the disruption in the:
    • Renin-angiotensin- aldosterone system 
Renal Manifestation of PHPT
Nephroclacinosis

#Arrangoiz #ParathyroidSurgeon #ParathyroidExpert #HeadandNeckSurgeon #EndocrineSurgery #MountSinaiMedicalCenter #Miami #Mexico #Teacher #Surgeon #Parathyroidectomy #Hypercalcemia #ElevatedCalcium #MSMC

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