title: The kidney in acromegaly: renal structure and function in patients with acromegaly during active disease and 1 year after disease remission.
abstract: BACKGROUND
  The GH/insulin-like growth factor 1 axis is physiologically involved in the regulation of electrolytes and water homeostasis by kidneys, and influences glomerular filtration and tubular re-absorption processes. The aim of the study was to investigate renal structure and function in acromegalic patients during active disease and disease remission.
  
  
  METHODS
  Thirty acromegalic patients (15 males and 15 females), aged 32-70 years, were enrolled for the study. Ten de novo patients had active disease, whereas 20 patients showed disease remission 1 year after medical treatment with somatostatin analogs (SA) (ten patients) or surgery (ten patients). Thirty healthy subjects matched for age, gender, and body surface area were enrolled as controls.
  
  
  RESULTS
  In both active (A) and controlled (C) patients, creatinine clearance (P<0.001) and citrate (P<0.05) and oxalate levels (P<0.001) were higher, whereas filtered Na (P<0.001) and K (P<0.001) fractional excretions were lower than those in the controls. Urinary Ca (P<0.001) and Ph (P<0.05) levels were significantly increased compared with the controls, and in patients with disease control, urinary Ca (P<0.001) levels were significantly reduced compared with active patients. Microalbuminuria was significantly increased in active patients (P<0.05) compared with controlled patients and healthy control subjects. The longitudinal (P<0.05) and transverse (P<0.05) diameters of kidneys were significantly higher than those in the controls. In all patients, the prevalence of micronephrolithiasis was higher than that in the controls (P<0.001), and was significantly correlated to disease duration (r=0.871, P<0.001) and hydroxyproline values (r=0.639, P<0.001).
  
  
  CONCLUSIONS
  The results of the current study demonstrated that acromegaly affects both renal structure and function. The observed changes are not completely reversible after disease remission.
authors.affiliation: Department of Molecular and Clinical Endocrinology and Oncology, University Federico II, via S. Pansini 5, Naples, Italy.
authors.forename: Renata S
authors.initials: RS
authors.lastname: Auriemma
authors.forename: Mariano
authors.initials: M
authors.lastname: Galdiero
authors.forename: Maria C
authors.initials: MC
authors.lastname: De Martino
authors.forename: Monica
authors.initials: M
authors.lastname: De Leo
authors.forename: Ludovica F S
authors.initials: LF
authors.lastname: Grasso
authors.forename: Pasquale
authors.initials: P
authors.lastname: Vitale
authors.forename: Alessia
authors.initials: A
authors.lastname: Cozzolino
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lombardi
authors.forename: Annamaria
authors.initials: A
authors.lastname: Colao
authors.forename: Rosario
authors.initials: R
authors.lastname: Pivonello
mesh_terms: D000172:Acromegaly / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D019343:Citric Acid / Q000378:metabolism; D003404:Creatinine / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D019343:Citric Acid; D013004:Somatostatin; D003404:Creatinine