Focus on renal morphology, chronic kidney disease, and urinary system malignancies in acromegaly: report on data collected over a 40-year period.

PURPOSE: Long-term renal consequences of acromegaly remain poorly characterized. We assessed prevalence and independent predictors of renal cysts, chronic kidney disease (CKD), and the frequency of urinary-system malignancies, in a large acromegaly cohort.

METHODS

394 acromegaly patients managed at a single tertiary center over four decades were retrospectively evaluated. Renal cyst and CKD predictors were identified by binary multivariate logistic regression with sensitivity analyses including IGF-1 exposure metrics; eGFR trajectories by nested analysis of covariance (ANCOVA). Standardized prevalence (SPRs) and incidence (SIRs) ratios were computed against age- and sex-stratified population references.

RESULTS

In 394 patients (202 male; median disease duration 17 years), renal cysts were present in 41.0% of imaged patients (47.4% bilateral), CKD in 16.1%, and nephrolithiasis in 15.1%. Among CKD patients, 64.9% had preserved eGFR (KDIGO G1-G2), reflecting albuminuria- or structure-driven ascertainment. Independent cyst predictors were age, nephrolithiasis, liver cysts, and multiple neoplasms; higher baseline potassium was inversely associated (OR 0.37, p = 0.013). Independent CKD predictors were age, male sex, hypertension, and nephrolithiasis. Cross-sectional and cumulative GH/IGF-1×ULN did not predict either outcome; cumulative IGF-1 was positively associated with follow-up eGFR (β=+1.69, p = 0.022), consistent with hyperfiltration. Age-matched SPRs were 1.23-1.98 for cysts (both p < 0.05) and 0.67 for CKD (p = 0.002); urinary-system cancers showed a > 7-fold excess (SIR 7.38, 2.97-15.20; p < 0.001).

CONCLUSIONS

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.