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Boggiano V, Barnhouse K, Rodriguez TG, Kim L. Recurrent multinodular goitre and primary hyperparathyroidism due to adenoma arising in a parathyroid autotransplant more than 20 years after near-total thyroidectomy. BMJ Case Rep 2023; 16:e256177. [PMID: 37977844 PMCID: PMC10660904 DOI: 10.1136/bcr-2023-256177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
The patient is a female in her 60s with a remote history of a near-total thyroidectomy in 1997 for multinodular goitre. At the initial operation, she sustained a left recurrent laryngeal nerve injury. A devascularised parathyroid gland was autotransplanted into the right sternocleidomastoid muscle. She had been off of thyroid hormone for long periods, and her most recent levothyroxine requirement had fallen to only 25 mcg daily. The patient presented more than 20 years after her thyroidectomy with hoarseness, fatigue and dyspnoea. Laboratory studies suggested primary hyperparathyroidism. Imaging demonstrated bilateral pulmonary emboli and bulky thyroid tissue extending into her mediastinum. She underwent a completion thyroidectomy with the removal of a parathyroid adenoma arising in the autotransplanted parathyroid. This case illustrates the possibility of regrowth of benign thyroid tissue after thyroidectomy. In addition, to our knowledge, this is the first case report of a parathyroid adenoma arising from autotransplantation of a normal parathyroid.
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Affiliation(s)
- Victoria Boggiano
- Department of Family Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathleen Barnhouse
- Department of Family Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Lawrence Kim
- Division of Surgical Oncology, UNC, Hillsborough, North Carolina, USA
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Liu M, Wu J, Gao M, Li Y, Xia W, Zhang Y, Chen J, Chen Z, Zhu Z, Chen H. Lifestyle factors, serum parameters, metabolic comorbidities, and the risk of kidney stones: a Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1240171. [PMID: 37810889 PMCID: PMC10560039 DOI: 10.3389/fendo.2023.1240171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background and objective The early identification of modifiable risk factors is important for preventing kidney stones but determining causal associations can be difficult with epidemiological data. We aimed to genetically assess the causality between modifiable factors (lifestyle factors, serum parameters, and metabolic comorbidities) and the risk of kidney stones. Additionally, we aimed to explore the causal impact of education on kidney stones and its potential mediating pathways. Methods We conducted a two-sample Mendelian randomization (MR) study to explore the causal association between 44 modifiable risk factors and kidney stones. The FinnGen dataset initially explored the causal relationship of risk factors with kidney stones and the UK Biobank dataset was used as the validation set. Then, a meta-analysis was conducted by combining discovery and validation datasets. We used two-step MR to assess potential mediators and their mediation proportions between education and kidney stones. Results The combined results indicated that previous exposures may increase the risk of kidney stones, including sedentary behavior, urinary sodium, the urinary sodium/potassium ratio, the urinary sodium/creatinine ratio, serum calcium, 25-hydroxyvitamin D (25OHD), the estimated creatinine-based glomerular filtration rate (eGFRcrea), GFR estimated by serum cystatin C (eGFRcys), body mass index (BMI), waist circumference, type 2 diabetes mellitus (T2DM), fasting insulin, glycated hemoglobin, and hypertension. Coffee intake, plasma caffeine levels, educational attainment, and the urinary potassium/creatinine ratio may decrease the risk of kidney stones. Ranked by mediation proportion, the effect of education on the risk of kidney stones was mediated by five modifiable risk factors, including sedentary behavior (mediation proportion, 25.7%), smoking initiation (10.2%), BMI (8.2%), T2DM (5.8%), and waist circumference (3.2%). Conclusion This study provides MR evidence supporting causal associations of many modifiable risk factors with kidney stones. Sedentary lifestyles, obesity, smoking, and T2DM are mediating factors in the causal relationship between educational attainment and kidney stones. Our results suggest more attention should be paid to these modifiable factors to prevent kidney stones.
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Affiliation(s)
- Minghui Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Wu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Meng Gao
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yongchao Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Weiping Xia
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Youjie Zhang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyong Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zewu Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Internal Medicine, Section Endocrinology, Yale University School of Medicine, New Haven, CT, United States
| | - Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Simmons KE, Nair HR, Phadke M, Motamedinia P, Singh D, Montgomery TA, Dahl NK. Risk Factors for Common Kidney Stones Are Correlated with Kidney Function Independent of Stone Composition. Am J Nephrol 2023; 54:329-336. [PMID: 37253348 DOI: 10.1159/000531046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/01/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Kidney stone type varies with age, sex, season, and medical conditions. Lower estimate glomerular filtration rate (eGFR) leads to changes in urine chemistry, and risk factors for kidney stones are thought to vary by stone type. We explore the association between eGFR, urine risk factors, and common stone compositions. METHODS This was a retrospective cohort study of 811 kidney stone patients seen at Yale Medicine between 1994 and 2021 with serum chemistries and 24-h urine chemistries matched within 1 year of baseline stone analysis. Patients' eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 equation. Demographics and medical history were compared by χ2 tests. 24-h urine chemistries and stone analyses were analyzed by one-way ANOVA. Linear regressions were performed to control for demographics, comorbidities, and stone composition. RESULTS With lower eGFR, the proportion of calcium stones declined while uric acid (UA) stones increased. On univariable analysis, lower eGFR was associated with lower urine pH, calcium, citrate, UA, magnesium, phosphorus, and ammonium. On multivariable analysis, controlling for age, sex, ethnicity, body mass index, comorbidities, and stone type, these factors remained significant. Stone formers with lower eGFR had elevated supersaturation for UA, but reduced supersaturations for calcium-containing stones. Though urine oxalate was significant on univariable analysis, it was not on multivariable analysis. CONCLUSION Changes in urine parameters are strongly correlated with eGFR regardless of stone type. Renal function may play a key role in modulating kidney stone risk factors. Strategies to mitigate stone risk may need to vary with kidney function, especially when patient urine or stone composition data are unavailable.
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Affiliation(s)
- Kathryn E Simmons
- Yale Section of Nephrology, Yale School of Medicine, New Haven, Connecticut, USA,
| | - Hari R Nair
- Yale Section of Nephrology, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Manali Phadke
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Piruz Motamedinia
- Yale Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dinesh Singh
- Yale Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Tinika A Montgomery
- Yale Section of Nephrology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Neera K Dahl
- Yale Section of Nephrology, Yale School of Medicine, New Haven, Connecticut, USA
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Shen Z, Wang R, He P, Zhang Z, Dai Y, Li M, Liu Z, Yang H, Guan S, Sun J. Association between urinary metal concentrations and abnormal estimated glomerular filtration rate in Chinese community-dwelling elderly: Exploring the mediating effect of triglycerides. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 259:114966. [PMID: 37182299 DOI: 10.1016/j.ecoenv.2023.114966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Environmental metal exposure is associated with elevated triglycerides (TG) and the development of chronic kidney disease (CKD). However, the relationship between metal exposure and glomerular filtration rate (GFR) remains uncertain, and the mediating effect of TG between the two is unclear. METHODS This study measured the concentrations of 14 metals in urine samples from 3752 elderly people in the community. The most relevant metals were screened by least absolute shrinkage and selection operator (LASSO) regression. The relationship between combined exposure to multiple metals and abnormal estimated glomerular filtration rate (eGFR) was explored using multivariate logistic regression analysis and Bayesian kernel machine regression (BKMR) analysis. Generalized linear regression models and the Karlson-Holm-Green (KHB) method were used to assess the mediating effects of TG. RESULTS In the single-metal model, calcium (Ca), iron (Fe), selenium (Se), strontium (Sr), and thallium (Tl) showed significant negative correlations with the prevalence of abnormal eGFR (all P < 0.05). In the multi-metals model, Ca, Se, and Tl continued to show significant negative correlations, while vanadium (V) and zinc (Zn) showed significant positive correlations with abnormal eGFR (all P < 0.05). The BKMR model showed a negative joint effect of the mixture of Ca, V, Zn, Se, and Tl on the prevalence of abnormal eGFR. The generalized linear regression model showed a significant positive correlation between the concentrations of Ca (β = 0.07), Zn (β = 0.07), Se (β = 0.09), and TG levels (all P < 0.05). In the mediation analysis, TG masked a 4.30% and 5.21% correlation between Ca and Se and the prevalence of eGFR abnormalities, respectively. CONCLUSIONS Urinary concentration of multiple metals is significantly associated with eGFR abnormalities, and Ca, and Se may be among the potential protective factors. TG masked some of the protective effects of Ca and Se.
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Affiliation(s)
- Zhuoheng Shen
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Rui Wang
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Pei He
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Zhongyuan Zhang
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Yuqing Dai
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Meiyan Li
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Zhihong Liu
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Huifang Yang
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China
| | - Suzhen Guan
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China.
| | - Jian Sun
- School of Public Health, Ningxia Medical University, Yinchuan Ningxia 750004, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan Ningxia 750004, P.R. China.
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Jian Z, Yuan C, Xiong Z, Li H, Jin X, Wang K. Kidney function may partially mediated the protective effect of urinary uromodulin on kidney stone. Urolithiasis 2023; 51:65. [PMID: 37022471 DOI: 10.1007/s00240-023-01441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/28/2023] [Indexed: 04/07/2023]
Abstract
The causal links between urinary uromodulin (uUMOD) and kidney stone disease (KSD) are still not clarified in general population. We assessed their relationships combining 2-sample Mendelian randomization (MR) and multivariable (MVMR) designs among general population of European ancestry. The summary information for uUMOD indexed to creatinine levels (29,315 individuals) and KSD (395,044 individuals) were from 2 independent genome-wide association studies (GWAS). The primary causal effects of exposures on outcomes were evaluated using inverse variance-weighted (IVW) regression model. Multiple sensitivity analyses were also performed. In 2-sample MR, we found that 1-unit higher genetically predicted uUMOD levels were associated with a lower risk of KSD (OR = 0.62; 95% CI 0.55-0.71; P = 2.83E-13). In reverse, we did not find the effect of KSD on uUOMD using IVW (beta = 0.00; 95% CI - 0.06-0.05; P = 0.872) and other sensitivity analyses. In MVMR, uUMOD indexed to creatinine levels were directly associated with the risk of KSD after introducing eGFR, SBP, urinary sodium or all three factors (OR = 0.71; 95% CI 0.64-0.79; P = 1.57E-09). Furthermore, our study supported that the protective effect of uUMOD on KSD may be partially mediated by eGFR (beta = - 0.09; 95% CI - 0.13 to - 0.06; mediation proportion = 20%). Our study supported that the protective effect of genetically predicted higher uUMOD levels on KSD may be partially mediated by eGFR decline, but not via SBP or urinary sodium. uUMOD might be a treatment target in preventing KSD in general population.
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Affiliation(s)
- Zhongyu Jian
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, People's Republic of China
- West China Biomedical Big Data Center, Sichuan University, Chengdu, People's Republic of China
| | - Chi Yuan
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zheyu Xiong
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Hong Li
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xi Jin
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, People's Republic of China.
| | - Kunjie Wang
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Abdalbary M, Chishti E, Shakhashiro M, Mohamed R, Parikh T, Nassar MK, Sayed-Ahmed N, Faugere MC, Sawaya BP, El-Husseini A. Impact of urinary calcium excretion on kidney, bone, and cardiovascular systems in patients with bone biopsy proven osteoporosis: a longitudinal long-term follow-up study. Osteoporos Int 2023; 34:763-774. [PMID: 36790470 DOI: 10.1007/s00198-023-06686-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
UNLABELLED The impact of urine calcium on kidney, bone, and cardiovascular systems in osteoporosis is not well-known. In this 7-year-follow-up study, high urine calcium did not affect kidney function but increased risk of kidney stones, while low urine calcium increased cardiovascular diseases. Maintaining normal urine calcium is beneficial for bone health. PURPOSE Hypercalciuria is common in patients with osteoporosis. However, the long-term effect of urinary calcium excretion (UCaE) on patients' health is not well-examined. The current study aims to assess the impact of UCaE on kidney, bone, and cardiovascular outcomes in patients with bone biopsy proven osteoporosis. METHODS Longitudinal study of all patients with osteoporosis who underwent bone biopsy and 24-h urine collection between 2008 and 2015 in the University of Kentucky. DXA scans, serum markers, kidney function, and cardiovascular events were recorded until last clinic visit in 2021. Exclusion criteria were secondary osteoporosis or conditions that might substantially impact UCaE. The significant results in univariate analysis were confirmed in multi-variable regression models involving clinically important covariates that might impact patients' outcomes. RESULTS Study included 230 patients with mean follow-up of 7.2 ± 2.9 years. The mean age was 61 years, and the mean eGFR at baseline was 85 ± 19 ml/min/1.73 m2. Low bone turnover (LBT) was present in 57% and high bone turnover (HBT) in 43% of patients. Hypercalciuria was found in one-third of patients with no difference between LTB and HTB. UCaE correlated positively with eGFR but did not affect the rate of eGFR decline over time. Higher UCaE predicted kidney stones development. We observed U-shaped effect of UCaE on bone health. Hypercalciuria predicted loss of BMD at all sites, but also hypocalciuria was associated with higher loss in total hip BMD. Upper limb fractures were the most observed fractures, and their incidence was higher in patients with hyper- or hypo-calciuria. Lower UCaE independently predicted development of major adverse cardiac events (MACE) and cardiovascular disease (CVD). CONCLUSION UCaE correlated with eGFR but it did not affect the change of eGFR over time. Patients with normal UCaE had lower incidence of upper limb fractures and less reduction in BMD. Low UCaE predicted MACE and CVD.
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Affiliation(s)
- M Abdalbary
- Mansoura Nephrology and Dialysis Unit, Mansoura University, 1 El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt.
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA.
| | - E Chishti
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA
| | - M Shakhashiro
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA
| | - R Mohamed
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA
| | - T Parikh
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA
| | - M K Nassar
- Mansoura Nephrology and Dialysis Unit, Mansoura University, 1 El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - N Sayed-Ahmed
- Mansoura Nephrology and Dialysis Unit, Mansoura University, 1 El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - M-C Faugere
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA
| | - B P Sawaya
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA
| | - A El-Husseini
- Division of Nephrology & Bone and Mineral Metabolism, University of Kentucky, Lexington, USA
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