Focus on renal morphology, chronic kidney disease, and urinary system malignancies in acromegaly: report on data collected over a 40-year period
Authors' conclusion
Renal cysts, CKD, and urinary-system malignancies are prevalent in acromegaly, with the long-term renal burden predominantly morphological and tubular rather than glomerular. Cross-sectional and cumulative GH/IGF-1 metrics did not predict CKD; age-matched CKD prevalence was lower than expected while cyst prevalence was elevated. The cyst and urinary-cancer excess support dedicated renal surveillance in long-term acromegaly management.
Study context
- Population
- Acromegaly patients managed at a single tertiary center over four decades; 202 male; median disease duration 17 years
- Participants
- 394 patients
- Outcome
- Prevalence and independent predictors of renal cysts and CKD, and frequency of urinary-system malignancies
Methodological detailssingle tertiary center, four decades
- Single tertiary center
- Four decades
Main finding
As reported in the abstract
- Renal cysts (of imaged patients)
- 41.0%
- Bilateral among renal cysts
- 47.4%
- Chronic kidney disease (CKD)
- 16.1%
- Nephrolithiasis
- 15.1%
- Age-matched SPR, cysts
- 1.23-1.98 (both p < 0.05)
- Age-matched SPR, CKD
- 0.67 (p = 0.002)
- Urinary-system cancers SIR (>7-fold excess)
- 7.38, 2.97-15.20; p < 0.001
Observational data: associations, not effects.
Further findings
CKD with preserved eGFR (KDIGO G1-G2) among CKD patients
- Preserved eGFR among CKD patients
- 64.9%
- Reflecting albuminuria- or structure-driven ascertainment
Independent predictors of renal cysts
- Higher baseline potassium, inverse association (OR)
- 0.37, p = 0.013
- Age, nephrolithiasis, liver cysts and multiple neoplasms
- Multivariate logistic regression
Independent predictors of CKD
- Age, male sex, hypertension and nephrolithiasis
- Multivariate logistic regression
GH/IGF-1 exposure and renal outcomes
- Cumulative IGF-1 vs follow-up eGFR (β)
- +1.69, p = 0.022
- Cross-sectional and cumulative GH/IGF-1×ULN did not predict cysts or CKD
- Consistent with hyperfiltration
Original publication
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