nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2021-25-1-59-69nefr-1931Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSЭкскреторная функция почек при первичном гиперпаратиреозе: кардиоренальный синдромRenal excretion function in primary hyperparathyroidism: cardio-renal syndromehttps://orcid.org/0000-0002-1341-0397МирнаяС. С.MirnayaS. S.

Мирная Светлана Сергеевна - кандидат медицинских наук, отделение патологии околощитовидных желез, старший научный сотрудник; eLibrary SPIN: 1968-7706

117036, Москва, ул. Дм. Ульянова, д. 11, раб. тел.: 8(495)500-0063, моб.: 8(903)734-45-81

Senior Researcher Mirnaya Svetlana Sergeevna - MD, Ph.D, Department of Pathology of the Parathyroid Glands, eLibrary SPIN: 1968-7706.

117036, Moscow, st. Dm. Ulyanov, 11 [address: 11 Dm. Ulyanova street, 117036 Moscow], work. 8 (495) 500-00-63, mob. 8 (903) 734-45-81

svetlanamirnaya@yahoo.comhttps://orcid.org/0000-0002-0067-3622МаганеваИ. С.MaganevaI. S.

Маганева Ирина Сергеевна - отделение патологии околощитовидных желез, научный сотрудник, eLibrarySPIN: 2575-3091

117036, Москва, ул. Дм. Ульянова, д. 11, раб. тел.: 8(495)500-00-63, моб.: 8(916)545-33-64

Researcher Maganeva Irina Sergeevna – MD, Department of Pathology of the Parathyroid Glands; eLibrary SPIN: 2575-3091.

117036, Moscow, st. Dm. Ulyanov, 11 [address: 11 Dm. Ulyanova street, 117036 Moscow, Russia], раб. 8(495)500-00-63, моб. 8(916)545-33-64

maganeva.ira@yandex.ruhttps://orcid.org/0000-0002-8916-7346ДобреваЕ. А.DobrevaE. A.

Добрева Екатерина Александровна - кандидат медицинских наук, отделение патологии околощитовидных желез, ведущий научный сотрудник; eLibrarySPIN: 3405-2467.

117036, Москва, ул. Дм. Ульянова, д. 11

Leading Researcher Dobreva Ekaterina Aleksandrovna, MD, PhD, Department of Pathology of the Parathyroid Glands; eLibrary SPIN: 3405-2467.

117036, Moscow, st. Dm. Ulyanov, 11 [address: 11 Dm. Ulyanova street, 117036 Moscow, Russia]

dobrevae@mail.ruhttps://orcid.org/0000-0002-9717-9742МокрышеваН. Г.MokryshevaN. G.

Чл.-кор. РАН Мокрышева Наталья Георгиевна - доктор медицинских наук, директор; eLibrarySPIN: 5624-3875.

117036, Москва, ул. Дм. Ульянова, д. 11, раб. 8(495)66820-79 (4040)

Mokrysheva Natalya Georgievna, MD, PhD, DMedSci, Department of Pathology of the Parathyroid Glands, Director; eLibrary SPIN: 5624-3875.

117036, Moscow, st. Dm. Ulyanov, 11 [address: 11 Dm. Ulyanova street, 117036 Moscow, Russia], work. 8 (495) 668-20-79 (4040)

Mokrisheva.Natalia@endocrincentr.ruФГБУ НМИЦ эндокринологии Минздрава РоссииРоссияEndocrinology Research CentreRussian Federation2021210120212515969Copyright © Мирная С.С., Маганева И.С., Добрева Е.А., Мокрышева Н.Г., 20212021Мирная С.С., Маганева И.С., Добрева Е.А., Мокрышева Н.Г.Mirnaya S.S., Maganeva I.S., Dobreva E.A., Mokrysheva N.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1931Введение

Введение. Первичный гиперпаратиреоз (ПГПТ) - заболевание эндокринной системы, развитие которого обусловлено формированием автономной избыточной секреции паратиреоидного гормона и патологией фосфорно-кальциевого обмена. ПГПТ ассоциирован со снижением функции почек и, как следствие, увеличением смертности. Поэтому нарушение функции почек, определяемое как скорость клубочковой фильтрации (СКФ) менее 60 мл/мин/1,73 м2, рассматривается как показание к хирургическому лечению. У ряда пациентов с ПГПТ возникает вторичный кардиоренальный синдром (5-го типа), который характеризуется наличием сочетанной почечной и кардиальной патологии. ЦЕЛЬ: оценить состояние экскреторной функции почек у пациентов с ПГПТ при манифестной и мягкой формах и ее динамику при хирургической и консервативной тактике ведения.

Пациенты и методы

Пациенты и методы. Проведено одномоментное сравнительное и проспективное исследование пациентов с ПГПТ. Для оценки функции почек на фоне выбранной тактики ведения через 6, 12 и/или 24 мес было выполнено клинико-лабораторное обследование, включавшее оценку тяжести ПГПТ и характеристику кардиоренального синдрома. Изменения СКФ были оценены у 29 пациентов после паратиреоидэктомии и у 27 пациентов с консервативной тактикой ведения (медикаментозного лечения и наблюдательной тактики). Продолжительность исследования составила до 24 мес. СКФ рассчитывали по формуле ModificationDietinRenalDiseaseStudy (MDRD). Стадию хронической болезни почек оценивали согласно современным рекомендациям.

Результаты

Результаты: В исследование включены 100 пациентов (10 мужчин и 90 женщин) с ПГПТ: из них 33 человека с мягкой формой ПГПТ и 67 человек с манифестной формой заболевания. Средний возраст составил 57 лет [51;61]. Средние значения СКФ составили 84,1 [73,3; 97,9] мл/мин/1,73 м2. Распространенность хронической болезни почек 3-4 стадии среди обследованных лиц была 11 %. Тактика ведения пациентов определялась в соответствии с международными рекомендациями. Изменения функции почек в отдаленном периоде после хирургического лечения характеризовались снижением СКФ в пределах 1-2 стадий хронической болезни почек, в том числе у больных с мягкой формой (p=0,013, W-test). Значимых изменений СКФ при проведении медикаментозного лечения и наблюдательной тактики не отмечалось. По результатам нашего анализа признаки кардиоренального синдрома (сочетание хронической болезни почек и кардиоваскулярной патологии) выявлены у 26 % пациентов с ПГПТ. Артериальная гипертензия зарегистрирована у 40 % пациентов с ПГПТ.

Заключение

Заключение: Выявлена высокая частота снижения функции почек у пациентов с ПГПТ, в том числе при мягкой форме заболевания. После проведения хирургического лечения и достижения ремиссии ПГПТ значимого улучшения фильтрационной функции почек не наблюдалось. Подтверждена безопасность консервативной тактики. Высокая частота кардиоваскулярной патологии у пациентов с ПГПТ не вызывает сомнений и диктует необходимость проведения проспективного исследования развития данного состояния на большей когорте пациентов.

Background

Background. Primary hyperparathyroidism (PHPT) is an endocrine disease, due to the formation of excess parathyroid hormone secretion and a disturbance of phosphorus-calcium metabolism. PHPT is associated with reduced renal function and related increased mortality, therefore renal function impairment defined as a glomerular filtration rate (GFR) less than 60 mL/ min/1.73 m2 is considered as an indication for surgical treatment. Some patients with PHPT have secondary cardio-renal syndrome (type 5), which is characterized by the presence of combined renal and cardiac pathology. THE AIM: Evaluate the GFR in patients with mild and symptomatic PHPT and its changes after parathyroidectomy and on medical treatment.

Patients and methods

Patients and methods: A cross-sectional comparative and prospective study was conducted on 100 patients with confirmed PHPT. A clinical and laboratory examination was performed at 6, 12, and/or 24 months and included an assessment of the PHPT complications as well as expression of cardio-renal syndrome according to the selected management tactics. Changes in GFR were evaluated in 29 patients after surgical treatment and in 27 patients on conservative management. Glomerular filtration rate was calculated by the Modification of Diet in Renal Disease Study (MDRD) formula. The chronic kidney disease (CKD) stage was estimated accordingly to current recommendations.

Results

Results: We included 100 patients (10 men and 90 women) with PHPT: 33 with mild and 67 with symptomatic PHPT. The median age was 57 years [51;61]. Mean GFR was 84,1 [73,3; 97,9] ml/ min/1,73 m2. Prevalence of CKD 3-4 in patients with PHPT was recorded at 11 %. Patient management tactics were determined in accordance with international recommendations. In the long-term period after surgery, we observed the decrease of GFR in patients with mild form within the limits of CKD 1-2 (p=0,013, W-test). No significant changes in GFR were noted during medical management and monitoring. Summary, the cardio-renal syndrome (CKD of any stage and cardiovascular pathology) was revealed in 26 % of patients. Arterial hypertension was registered in 40 %.

Conclusions

Conclusions: We found a high frequency of renal function impairment in patients with PHPT, including patients with a mild form of the disease. We did not observe any significant improvement in renal filtration function, after surgical treatment and remission of PHPT. The safety of conservative tactics has been confirmed. The high frequency of cardiovascular pathology in patients with PHPT is beyond doubt and requires prospective studies in the larger cohorts of patients.

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The authors declare that there are no conflicts of interest present.