L’introduzione dei nuovi criteri chirurgici renali nelle linee guida per la gestione dell’ Iperparatiroidismo Primario Asintomatico è relativamente recente e non sono ancora presenti dati in letteratura che confermino la validità di questi criteri nell’individuare i pazienti a maggior rischio.
I risultati di questo studio indicano che la sola valutazione della calciuria non è sufficiente per individuare i pazienti che potrebbero essere a maggior rischio, ma i pazienti con calciuria > 400 mg/24h hanno valori più elevati anche di sodiuria, fosfaturia, magnesiuria, cloruria e ossaluria, nonché indici di saturazione urinaria più elevati rispetto ai pazienti con calciuria < 400 mg/24h. Dunque avere una calciuria > 400 mg/24h comporta una maggiore probabilità di avere anche altre alterazioni del profilo biochimico urinario. Inoltre, abbiamo riscontrato che nei pazienti con calciuria > 400 mg/24h la prevalenza della nefrolitiasi è maggiore rispetto a quelli con calciuria < 400 mg/24h. Se ne deduce che questo cut-off è un valido discriminante per decidere in quali casi approfondire la valutazione del profilo biochimico urinario.
L’associazione di calciuria > 400 mg/24h ed aumentato profilo di rischio litogeno individua una coorte di pazienti nei quali si sono già sviluppate le complicanze renali della malattia o in cui è più probabile che esse si sviluppino, condizione che l’intervento di paratiroidectomia andrebbe a migliorare.
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Gli stone formers tendono ad avere con maggiore frequenza la calcemia superiore di almeno 1 mg/dl rispetto al range di normalità ed hanno livelli sierici di paratormone significativamente più elevati rispetto ai
non stone formers. Inoltre, la calciuria e gli indici di saturazione urinaria
sono significativamente più alti negli stone formers rispetto ai non stone
formers. Questi dati confermerebbero l’importanza di sottoporre ad
intervento i pazienti che presentino almeno uno tra i nuovi criteri chirurgici renali, in modo da ridurne morbilità e mortalità potenzialmente correlate alle complicanze renali dell’ Iperparatiroidismo Primario.
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