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Bewertung von renalem zyklischen Adenosinmonophosphat, Serum-Parathormon und Phosphat-Rückresorption bei rezidivierender Calcium-Urolithiasis, Gesunden und Hyperparathyreoidismus

Evaluation of renal cyclic adenosine monophosphate, serum parathyroid hormone and phosphate reabsorption in recurrent calcium urolithiasis, healthy controls and hyperparathyroidism

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Summary

In three groups (n=12 each) of male controls (22–43 years), patients with recurring calcium urolithiasis (21–36 years) and hyperparathyroidism (HPT; 17–71 years) proven by surgery renal cyclic adenosine monophosphate (RcAMP), fractional tubular phosphate reabsorption and serum parathyroid hormone (PTH) were measured during endogenous creatinine clearance. RcAMP (µMol/g creatinine) was: controls 1.48±SEM 0.27; stone formers 2.037±0.343 (not significantly different); HPT 6.234±0.454 (p<0.001). There is no overlap between HPT and controls. Phosphate reabsorption is least in HPT (0.84±0.015), higher in controls (0.924±0.004) and stone formers (0.941±0.007). All differences are statistically significant. Under the conditions selected (moderate hydration of individuals) Serum PTH (pg-equiv/ml) is lowest in stome formers (<100–339), higher in controls (<100–933) and HPT (400–1150). There is no overlap in PTH between the former and the latter group but a marked one between controls and HPT. For clinical purposes the resulting diagnostic uncertainty in a given patient can be overcome by additional determinations of RcAMP and ionised serum calcium: when referring to serum PTH HPT patients fall outside, RCU patients within 2 standard deviations of either parameter in control subjects. This procedure presently appears superior to those proposed in the past (urinary cAMP etc.) but requires confirmation in larger patient populations. Moreover, since HPT prevails in middle and upper age decades, their RcAMP values and those of RCU patients should be related to a range seen in closely age- and sex-matched controls.

Zusammenfassung

An drei Kollektiven (jen=12) von männlichen Gesunden (22–43 Jahre), Patienten mit rezidivierender Calcium-Urolithiasis (21–36 Jahre), Hyperparathyreoidismus (HPT; 17–71 Jahre) wurden gleichzeitig renales zyklisches Adenosinmonophosphat (RcAMP), fraktionelle tubuläre Phosphat-Rückresorption und Serum-Parathormon während endogener Kreatininclearance gemessen. Gesunde haben ein RcAMP (µMol/g Kreatinin) von 1,48±SEM 0,27; Steinkranke 2,037±0,343 (nicht signifikant); HPT 6,234±0,454 (p<0,001). Zwischen HPT und Gesunden besteht kein Überlappungsbereich. Die Phosphat-Rückresorption ist am niedrigsten bei HPT (0,84±0,015), höher bei Gesunden (0,924±0,007), am höchsten bei Steinkranken (0,941±0,007). Alle Gruppenunterschiede sind statistisch signifikant. Parathormon (pg-equiv/ml) ist unter den gewählten Bedingungen, d.h. mäßige Hydrierung der Versuchsperson, am niedrigsten bei Steinkranken (<100–339), höher bei Gesunden (<100–933), am höchsten bei HPT (400–1150). Zwischen ersteren und letzeren besteht kein Überlappungsbereich, wohl aber zwischen Gesunden und HPT. Die resultierende diagnostische Unsicherheit kann im Einzelfall durch zusätzliche Bestimmungen von RcAMP und ionisiertem Serum-Calcium umgangen werden: Serum-PTH beachtend liegt HPT außerhalb, RCU innerhalb der 2-Sigmabereiche Gesunder. Ein solches diagnostisches Vorgehen erscheint bisherigen Verfahren überlegen, bedarf aber der Ausdehnung auf ein größeres Krankengut. Da HPT eine Krankheit des mittleren und gehobenen Alters ist, muß außerdem die Erstellung von Normbereichen für RcAMP bei Gesunden dieser Altersdekaden angestrebt werden.

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Authors and Affiliations

  1. Chirurgische und Urologische Klinik, Mineralstoffwechsel- und Hormonlabor, Universität Erlangen-Nürnberg, Germany

    P. O. Schwille, Ch. Bornhof, R. Thun, D. Scholz, R. Bötticher, W. Schellerer & A. Sigel

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  1. P. O. Schwille
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  2. Ch. Bornhof
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  3. R. Thun
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  4. D. Scholz
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  5. R. Bötticher
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  6. W. Schellerer
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  7. A. Sigel
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Schwille, P.O., Bornhof, C., Thun, R. et al. Bewertung von renalem zyklischen Adenosinmonophosphat, Serum-Parathormon und Phosphat-Rückresorption bei rezidivierender Calcium-Urolithiasis, Gesunden und Hyperparathyreoidismus. Klin Wochenschr 56, 601–606 (1978). https://doi.org/10.1007/BF01477008

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  • DOI: https://doi.org/10.1007/BF01477008

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