Akromegaliye Eşlik Eden Böbrek Hastalıklarının Retrospektif Analizi
Özet
Acromegaly is a rare disease characterized by systemic findings due to chronic growth hormone (GH) and insulin-like growth factor-1 (IGF-1) exposure. In addition to its systemic effects, the disease has been associated with renal comorbidities such as renal hypertrophy, albuminuria, glomerular sclerosis, and renal cyst formation. The aim of our study is to examine the frequency and possible risk factors of kidney diseases in patients with acromegaly. For this purpose, adult patients who were followed up with a diagnosis of acromegaly at Hacettepe University, Department of Endocrinology and Metabolic Diseases between 1980 and 2023 were included in the study, provided that their medical records could be accessed. The demographic characteristics of the patients, comorbid diseases, laboratory results, surgical and medical treatments, and radiological and histopathological features of the tumor were examined retrospectively. Risk factors for chronic kidney disease and renal cyst formation were investigated using statistical methods. The mean age of 394 [202 (51.3%) men and 192 (48.7%) women] patients included in the study was 56.9±12.5 years (range, 27-89). 16.1% (57/354) and 41% (116/283) patients had CKD and kidney cyst/s, respectively. Multivariate analysis revealed that advanced age (OR: 1.052, 95% CI: 1.015-1.089, p=0.005), male gender (OR: 3.575, 95% CI: 1.811-7.056, p<0.001) and hypertension (OR: 2.786, 95% CI: 1.316-5.901, p=0.007) were independent risk factors for CKD. In addition, it was revealed that the presence of thyroid nodule, nephrolithiasis and plurihormonal pituitary adenoma are predictors of CKD independent of age, gender and hypertension. In the multiple regression model in which risk factors for kidney cysts were investigated, advanced age (OR: 1.049, 95% CI: 1.022-1.076, p<0.001), nephrolithiasis (OR: 2.455, 95% CI: 1.170-5.153, p=0.018), liver cyst/s (OR: 2.657, 95% CI: 1.291-5.467, p=0.008), and the presence of multiple neoplasms (OR: 1.915, 95% CI: 1.015-3.612, p=0.045) were defined as independent risk factors for the development of kidney cysts. It was demonstrated that low pre-treatment serum potassium levels and the occurrence of Ki-67 index <3% are independent predictors for the development of kidney cysts, independent of age, nephrolithiasis, liver cyst and the presence of multiple neoplasms. In contrast to the literature, the study observed a higher frequency of male gender in individuals with CKD among acromegaly patients. Additionally, an association between CKD and TSH+ plurihormonal staining was noted.
