ACUTE and LONG-TERM Changes of Renal Function after Parathyroidectomy for Primary Hyperparathyroidism

Presentation Number: SUN 334
Date of Presentation: April 2nd, 2017

Marcelo Belli1, Regina M Martin1, Marilia Guimaraes Brescia1, Climerio Pereira Nascimento Jr.1, Ledo Mazzei Massoni-Neto1, Sergio Samir Arap1, Bruno Ferraz-de-Souza2, Rosa Maria Moyses1, Munro Peacock3 and Fabio Luiz de Menezes Montenegro*4
1Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil, 2Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil, 3Indiana Univ Sch Med/Univ Hosp, Indianapolis, IN, 4Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil, Sao Paulo, Brazil

Abstract

Fuller Albright observed that “almost all patients with hyperparathyroidism have a marked oliguria immediately following the successful removal of a parathyroid adenoma. In some instances it may be sufficient to cause alarm” (1). In kidney transplant patients, parathyroidectomy was associated with acute decrease of renal function. Acute and long-term kidney functions are not fully studied in primary hyperparathyroidism (pHPT). We retrospectively analyzed renal function of patients undergoing parathyroidectomy for pHPT in a single teaching hospital. From 2007 to 2014, preoperative and early postoperative creatinine levels from 387 of 404 patients undergoing parathyroidectomy for pHPT were available. Most were female (310, 80%) and white (329, 85%), with uniglandular parathyroid disease (276, 71.3%). Mean age at the operation was 57.4 years (range 18-85)., with median (normal range) preoperative Total Calcium, Phosphorus and PTH of 10.8mg/dL,(8.6-10.2), 2.7 mg/dL (2.7-4.5) , 164 pg/mL (10-65), respectively. Mean preoperative estimated glomerular filtration rate (eGFR) was 82 mL/min and it decreased to a nadir of 62 mL/min until the fourth day after the operation. According to the Kidney Diseases: Improving Global Outcomes (KDIGO)  criteria for acute kidney injury (AKI), 39% presented stage 1 AKI, 5.4% stage 2 AKI and 3.1% stage 3 AKI. Although the percentual decrease in eGFR was statistically correlated to age, PTH, Calcium, Phosphorus and preoperative eGFR, the associations were weak and they precluded multivariate analysis. In 218 cases, Repeated Measures ANOVA of preoperative eGFR (mean 79.7 mL/min), was significantly different from early postoperative (58.4 mL/min), and the values at one month (73.4 mL/min), 12 months (73.7 mL/min) and 24 months (73.3 mL/min) ((p<0,0001). There were no differences in the values of one, 12 and 24 months. Present data shows that there is an acute change of renal function after the operation for pHPT in almost half of the cases. The recovery seems to be rapid, but a statistically significant permanent decrease was present. Fortunately, if a true renal damage occurs, it is slight and it did not impact in the outcome of most patients. The mechanism of such change deserves further evaluation and we speculate if preoperative kidney function may be falsely overestimated in patients with pHPT, due to some metabolic effect of parathyroid hormone or hypercalcemia.

 

Disclosure: RMM: Teacher, Amgen. Nothing to Disclose: MB, RMM, MGB, CPN Jr., LMM, SSA, BF, MP, FLDMM