Archives of Head and Neck Surgery
https://archivesheadnecksurgery.com/article/doi/10.4322/ahns.2018.0886
Archives of Head and Neck Surgery
Original Article Parathyroid diseases and Tumors

Evolution of renal function in patients with primary hyperparathyroidism submitted to parathyroidectomy

João Henrique Zanotelli dos Santos, Mariana Junqueira Reis Enout, Adriana Terumi Shimozono, Larissa Izumi Fujjiz, Lillian Andrade de Rocha, Rodrigo Oliveira Santos, Murilo Catafesta das Neves

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Abstract

Introduction: Primary hyperparathyroidism (PHPT) is a hypercalcemic disorder resulting from inappropriate parathyroid secretion (PTH). The surgical treatment is considered the mainstay of therapy. Several studies have observed the worsening of renal function in these patients after parathyroidectomy (PTX), however, the pathophysiology of this phenomenon is unknown. Objective: The purpose of this study is to describe the postoperative renal function in patients with PHPT operated at the Federal University of São Paulo - UNIFESP- between the years 2007 and 2016, evaluating the risk factors for renal function decline. Materials and Methods: This is a cohort study. A total of 142 patients were divided into two groups according to their renal function: Group I (> 60 mL / min / 1.73 m2) and Group II (<60 mL / min / 1.73 m2). Results: Increased serum creatinine was observed in both groups in the first 96 hours, with partial recovery over the first month. Creatinine values> 1.82 mg / dL in patients with renal disease are associated with worse prognosis for renal function after surgery and PTH values> 400 pg / dL are associated with a poor renal outcome, independent of previous renal function. Conclusion: Patients with elevated baseline PTH and creatinine had a worse outcome of renal function one year after surgery

Keywords

primary hyperparathyroidism; parathyroidectomy; renal insufficiency; postoperative period; glomerular filtration rate.

References

1. Khan AA, Hanley DA, Rizzoli R, Bollerslev J, Young JE, Rejnmark L, Thakker R, D’Amour P, Paul T, Van Uum S, Shrayyef MZ, Goltzman D, Kaiser S, Cusano NE, Bouillon R, Mosekilde L, Kung AW, Rao SD, Bhadada SK, Clarke BL, Liu J, Duh Q, Lewiecki EM, Bandeira F, Eastell R, Marcocci C, Silverberg SJ, Udelsman R, Davison KS, Potts JT Jr, Brandi ML, Bilezikian JP. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int. 2017;28(1):1-19. PMid:27613721.

2. Felsenfeld AJ, Levine BS, Kleeman CR. Fuller Albright and our current understanding of calcium and phosphorus regulation and primary hyperparathyroidism. Nefrologia. 2011;31(3):346-57. PMid:21629339.

3. Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, Potts JT Jr. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab. 2014;99(10):3561-9. http://dx.doi.org/10.1210/jc.2014-1413. PMid:25162665.

4. Montenegro FLM, Martin RM, Lourenço DM Jr, Arap SS, Nascimento CP Jr, Brandão LG. Alteração transitória da taxa de filtração glomerular após paratireoidectomia independe da função renal pré-operatória. Rev Bras Cir Cabeça Pescoço. 2010;39(2):99-102.

5. Tassone F, Guarnieri A, Castellano E, Baffoni C, Attanasio R, Borretta G. Parathyroidectomy Halts the Deterioration of Renal Function in Primary Hyperparathyroidism. J Clin Endocrinol Metab. 2015;100(8):3069-73. http://dx.doi.org/10.1210/jc.2015-2132. PMid:26079781.

6. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Especializada e Temática. Diretrizes clínicas para o cuidado ao paciente com doença renal crônica – DRC no Sistema Único de Saúde. Brasília: Ministério da Saúde; 2014.

7. Levi TM, de Souza SP, de Magalhães JG, de Carvalho MS, Cunha AL, Dantas JG, Cruz MG, Guimarães YL, Cruz CM. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients. Rev Bras Ter Intensiva. 2013;25(4):290-6. PMid:24553510.

8. Neves MC, Ohe MN, Rosano M, Abrahão M, Cervantes O, Lazaretti-Castro M, Vieira JGH, Kunii IS, Santos RO. A 10-year experience in intraoperative parathyroid hormone measurements for primary hyperparathyroidism: a prospective study of 91 previous unexplored patients. J Osteoporos, 2012;2012:914214.

9. Ohe MN, Santos RO, Kunii IS, Abrahão M, Cervantes O, Carvalho AB, LazarettiCastro M, Vieira JG. Utilidade da medida de PTH intra-operatório no tratamento cirúrgico do hiperparatiroidismo primário e secundário: análise de 109 casos. Arq Bras Endocrinol Metabol. 2006;50(5):869-75. http://dx.doi.org/10.1590/S0004-27302006000500007. PMid:17160210.

10. Grams ME, Sang Y, Coresh J, Ballew S, Matsushita K, Molnar MZ, Szabo Z, KalantarZadeh K, Kovesdy CP. Acute Kidney Injury After Major Surgery: A Retrospective Analysis of Veterans Health Administration Data. Am J Kidney Dis. 2016;67(6):872-80. http://dx.doi.org/10.1053/j.ajkd.2015.07.022. PMid:26337133.

11. Kimmel LA, Wilson S, Janardan JD, Liew SM, Walker RG. Incidence of acute kidney injury following total joint arthroplasty: a retrospective review by RIFLE criteria. Clin Kidney J. 2014;7(6):546-51. http://dx.doi.org/10.1093/ckj/sfu108. PMid:25859370.

12. Chung CU, Nelson JA, Fischer JP, Wink JD, Serletti JM, Kovach SJ. Acute kidney injury after open ventral hernia repair: an analysis of the 2005–2012 ACS-NSQIP datasets. Hernia. 2016;20(1):131-8. http://dx.doi.org/10.1007/s10029-015-1395-0. PMid:26099501.

13. Lim SY, Lee JY, Yang JH, Na YJ, Kim MG, Jo SK, Cho WY. Predictive factors of acute kidney injury in patients undergoing rectal surgery. Kidney Res Clin Pract. 2016;35(3):160-4. http://dx.doi.org/10.1016/j.krcp.2016.05.006. PMid:27668159.

14. Parikh S, Nagaraja H, Agarwal A, Samavedi S, Von Visger J, Nori U, Andreoni K, Pesavento T, Singh N. Impact of post-kidney transplant arathyroidectomy on allograft function. Clin Transplant. 2013;27(3):397-402. http://dx.doi.org/10.1111/ctr.12099. PMid:23448282.

15. Schwarz A, Rustien G, Merkel S, Radermacher J, Haller H. Decreased renal transplant funtion after parathyreoidectomy. Nephrol Dial Transplant. 2007;22(2):584-91. http://dx.doi.org/10.1093/ndt/gfl583. PMid:17035377.

16. Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int. 2012;81(5):442-8. http://dx.doi.org/10.1038/ki.2011.379. PMid:22113526.

17. Endlich K, Massfelder T, Helwig JJ, Steinhausen M. Vascular effects of parathyroid hormone and parathyroid hormone-related protein in the split hydronephrotic rat kidney. J Physiol. 1995;483(Pt 2):481-90. http://dx.doi.org/10.1113/jphysiol.1995. sp020599. PMid:7650615.

18. Clemens TL, Cormier S, Eichinger A, Endlich K, Fiaschi-Taesch N, Fischer E, Friedman PA, Karaplis AC, Massfelder T, Rossert J, Schlüter KD, Silve C, Stewart AF, Takane K, Helwig JJ. Parathyroid hormone-related protein and its receptors: nuclear functions and roles in the renal and cardiovascular systems, the placental trophoblasts and the pancreatic islets. Br J Pharmacol. 2001;134(6):1113-36. http://dx.doi.org/10.1038/sj.bjp.0704378. PMid:11704631.

19. Peacock M. Primary hyperparathyroidism and the kidney: biochemical and clinical spectrum. J Bone Miner Res. 2002;17(Suppl 2):N87-94. PMid:12412783.

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