Nephrocalcinosis, renal dysfunction and calculi in patients with primary hypoparathyroidism on long-term conventional therapy.

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There are concerns about the long-term safety of conventional therapy on renal health in patients with hypoparathyroidism. Careful audit of these would help comparison with the upcoming PTH therapy.We investigated nephrocalcinosis, renal dysfunction and calculi, their predictors and progression over long-term follow-up in patients with primary hypoparathyroidism (PH).Observational study at tertiary-care center.165 hypoparathyroid patients receiving conventional therapy were evaluated by radiographs, ultrasonography and computed tomography. Their glomerular-filtration rate (GFR) was measured by Tc-99m-diethylenetriamine penta-acetic acid clearance. Clinical characteristics, serum total calcium, phosphorus, creatinine, hypercalciuria, fractional excretion of phosphorus (FEPh) at presentation and during follow-up was analyzed as possible predictors of renal complications. Controls were 165 apparently healthy subjects.Nephrocalcinosis was present in 6.7% of hypoparathyroid patients but not in controls. Patients with age < 15 years at presentation and with higher serum calcium-phosphorus product were at a higher risk. Nephrocalcinosis showed no significant association with cataract and intracranial calcification. Prevalence of renal calculi was comparable between hypoparathyroid patients and controls (5% vs. 3.6%, P = 0.58). 14% of patients had GFR < 60 ml/min/1.73m2.. Increased FEPh during follow-up was the significant predictor of low GFR. Nephrocalcinosis developed in 9% of patients over 10 years of conventional therapy.6.7% of patients with primary hypoparathyroidism had nephrocalcinosis and 14% showed renal dysfunction. Prevalence of renal calculi was similar in patients and controls. 9.0% of patients developed nephrocalcinosis over 10 years of conventional therapy.

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