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

Authors

Polat Ercan, Busra Firlatan Yazgan, Suleyman Nahit Sendur, Seda Hanife Oguz, Selcuk Dagdelen, Tomris Erbas

Published in

Pituitary. Volume 29. Issue 4. Jun 19, 2026. Epub Jun 19, 2026.

Abstract

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.
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.
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).
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.

PMID:
42321588
Bibliographic data and abstract were imported from PubMed on 20 Jun 2026.

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