Treatable glomerular hyperfiltration in patients with active acromegaly

Author:

Fujio Shingo1,Takano Koji2,Arimura Hiroshi3,Habu Mika1,Bohara Manoj1,Hirano Horofumi1,Hanaya Ryosuke1,Nishio Yoshihiko3,Koriyama Chihaya4,Kinoshita Yasuyuki5,Arita Kazunori1

Affiliation:

1. 1Department of NeurosurgeryGraduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan

2. 2Department of EndocrinologyDiabetes and Metabolism, School of Medicine, Kitasato University, Sagamihara, Japan

3. 3Department of DiabetesMetabolism and Endocrinology

4. 4Department of Epidemiology and Preventive MedicineGraduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan

5. 5Department of NeurosurgeryGraduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan

Abstract

Objective The glomerular filtration rate (GFR) is increased in patients with active acromegaly. The aim of this study is to elucidate whether renal function deteriorates in patients with acromegaly and whether this deterioration is reversible after surgical remission. Design/methods A case–control study of 48 acromegalic patients who were surgically cured (cases) and 48 patients with nonfunctioning pituitary adenomas (NFomas, controls) was conducted. We performed clinical and biochemical examinations before surgery and 3months post-surgery. The GFR of each patient was estimated (estimated GFR, eGFR) using their serum creatinine, age, sex, and body surface area, and postoperative changes in the eGFR were assessed. Results The preoperative eGFR was significantly higher in patients with acromegaly than in those with NFoma (99.8 vs 75.1mL/min respectively, P<0.01). In acromegalic patients, surgical remission was accompanied by a significant decline in the eGFR (from 99.8 to 86.2mL/min, P<0.01). Conversely, in patients with NFoma, the postoperative eGFR did not change significantly (from 75.1 to 81.9mL/min, P=0.12). Among the acromegalic patients, the postoperative decreases in the eGFR were more prominent in patients with a preoperatively high or normal vs low eGFR. Conclusions Our data demonstrated a significant post-surgical eGFR decrease in patients with acromegaly, but not in patients with NFomas. This change in the eGFR was reversible in acromegalic patients with a high/normal preoperative eGFR, but not in those with a low preoperative eGFR. This suggests that the reversible pathophysiological change in some patients is functional but not organic.

Publisher

Bioscientifica

Subject

Endocrinology,General Medicine,Endocrinology, Diabetes and Metabolism

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