Secondary Hyperparathyroidism

Protracted hypocalcemia is the most common complication after parathyroidectomy for secondary hyperparathyroidism. Several parameters have been identified to predict the degree of postoperative hypocalcemia. The purpose of this study was to determine whether there were any factors associated with prolonged hospitalization in these patients. A total of 81 consecutive patients with end-stage renal disease and advanced secondary hyperparathyroidism who underwent parathyroidectomy between January 2004 and December 2006 were studied. The postoperative calcium infusion protocol and discharge criteria were standardized. Clinical variables were compared between patients with a shorter or longer postoperative stay. The mean postoperative hospital stay was 5.6 days. Preoperative alkaline phosphatase levels were significantly higher in patients with a longer stay (p=0.035). In a linear regression model, the postoperative length of stay was moderately but significantly correlated with preoperat...

Secondary hyperparathyroidism is a frequently encountered problem in the management of patients with chronic kidney disease (CKD). Its pathophysiology is mainly due to hyperphosphatemia and vita-min D deficiency and resistance. This condition has a high impact on the mortality and morbidity of di-alysis patients. Early diagnosis of secondary hyperparathyroidism is crucial in the management of pa-tients with CKD. The treatment remains a challenge for patients and their clinicians. It should include a combination of dietary phosphorus restriction, phosphate binders, vitamin D analogues, and calcimi-metics. (J Am Board Fam Med 2009;22:574–581.) Background The prevalence of chronic kidney disease (CKD) in the United States has increased from 10 % during

To evaluate, by means of a prospective randomized study, the efficacy of cinacalcet in the forms of nephrolithiasis associated with primary hyperparathyroidism in both the hypercalcemic and normocalcemic variant. Ten patients suffering from active nephrolithiasis associated with primary hyperparathyroidism (4 hypercalcemics and 6 normocalcemics), equally divided between males and females, were randomly but not blindly addressed to treatment with potassium citrate and allopurinol, or to the same therapeutic regimen in combination with cinacalcet. The dosage of cinacalcet was optimized for each patient in order to obtain a reduction of parathyroid hormone (PTH) within normal limits while enabling the maintenance of adequate calcemic values. All study participants were given the same diet based on a reduction in sodium intake, oxalate-rich foods and animal protein with standardized intake of calcium and an increase in hydration. After a follow up period of 10 months , cinacalcet was as...

Alfacalcidol and paricalcitol are vitamin D analogs used for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease, but have known dose-dependent side effects that cause hypercalcemia and hyperphosphatemia. In this investigator-initiated multicenter randomized clinical trial, we originally intended two crossover study periods with a washout interval in 86 chronic hemodialysis patients. These patients received increasing intravenous doses

The influence of secondary hyperparathyroidism (2 HPT) on the set point of the parathyroid hormone (PTH)-Ca2+ curve is controversial. In vitro experiments have shown an increase in the set point. However, clinical studies with hemodialysis patients have provided a variety of results (increases, decreases and no changes in the set point have been reported). The present study was designed to investigate the influence of the progression of 2 HPT on the set point of the PTH-Ca2+ curve. The PTH-Ca2+ curve and the expression of parathyroid calcium receptor (CaR mRNA) and vitamin D receptor (VDR mRNA) have been studied in normal rabbits (group I, n=9) and in nephrectomized rabbits (group II, n=18) at two stages after inducing 2 HPT: 2–3 weeks (group IIA) and 5–6 weeks (group IIB). In group I, the set point of the PTH-Ca2+ curve was 1.63±0.03 mM. A progressive hypocalcemia was detected during the evolution of 2 HPT (groups IIA and IIB). Rabbits from group IIA had a significant…

From Denver Nephrologists, Denver (GAB); Saint Louis University, St. Louis (KJM); Hospital Marqués de Valdecilla, Santander, Spain (ALMF); Amgen, Thou-sand Oaks, Calif. (SAT, LCM, VJZ, KAO); Long Island College Hospital, Brooklyn, NY (MMA); Liverpool Hospi-tal, ...

It is known that nursing-home patients with vitamin D insufficiency have elevated serum parathyroid hormone (PTH) as well as raised serum alkaline phosphatase (ALP). Although it is well known that vitamin D insufficiency and secondary hyperparathyroidism are common among the elderly in western countries, there is continuing controversy over the level of serum 25-hydroxyvitamin D [25(OH)D] necessary for bone health.

There has been an emphasis over the last several years to identify and treat chronic kidney disease (CKD) and its complications as they evolve rather than waiting until the patient reaches end-stage renal disease (ESRD), also known as CKD stage 5. The number of patients who will be identified and prescribed therapies for complications such as secondary hyperparathyroidism (SHPT) is greater than initially proposed. To review the pathways, complications, management, and estimated treatment costs of CKD-related SHPT. An electronic literature search of MEDLINE (January 1980 through January 2007) was conducted for English-language publications using the base search term secondary hyperparathyroidism. To refine subsequent searches, the authors added Boolean operators to the following secondary and tertiary search terms: parathyroid hormone, chronic kidney disease, renal osteodystrophy, adynamic bone disease, vascular calcification, cardiovascular disease, vitamin D, vitamin D analogs, hyp...

Primary oxalosis is a rare inborn error of oxalate metabolism. Most cases are discovered in children, but occasionally symptoms begin later in life. Since early deaths in the past were from renal failure, prolonged survival obtained with chronic dialysis allows oxalosis to develop. This paper presents a 38-year-old man with an atypical history of type-I primary hyperoxaluria, not diagnosed until after 5 years of dialysis. Bone biopsy was performed because the biochemical and radiologic features did not seem consistent with a putative diagnosis of secondary hyperparathyroidism. This case emphasizes the clinical heterogeneity of this disorder, and the need for its considerations in the spectrum of dialysis-related bone diseases. It also stresses that bone oxalosis may mimic hyperparathyroidism, especially radiologically. Differential diagnosis is therefore mandatory.

Primary hyperparathyroidism is defined by the presence of hypercalcaemia (>2.6 mmol/litre) in the presence of inappropriate (i.e. not inhibited) or high PTH levels. The cause remains unknown and most patients (>85%) have a single adenoma. In modern medical practice most patients are deemed asymptomatic at the time of diagnosis. The traditional mnemonic of ‘bones/groans/stones/moans’ is rarely seen. A combination of neck ultrasound and Sestamibi scanning demonstrates the position of adenomas in some two thirds of patients and they can benefit from a minimally invasive parathyroidectomy done under general anaesthesia or under sedation/local anaesthesia. Patients with negative scans need bilateral neck exploration. Medical treatment is reserved for patients with failed surgical treatment or those with limited life expectancy considered too unwell for surgical intervention.Secondary hyperparathyroidism is a physiological response to a metabolic drive (e.g. chronic renal failure) t...

It is well known that secondary hyperparathyroidism may be an extremely severe condition in chronic renal failure, and almost all patients with chronic kidney disease, even in the well-developed countries, encounter every kind of bone abnormalities if they are not treated properly. ...

Stage 5 chronic kidney disease is commonly complicated by bone mineral disease, leading to an increased risk of morbidity and mortality. Currently, there is a trend toward a lesser use of calcium salts and calcitriol and an increased use of low-calcium dialysate. We report the case of a patient under peritoneal dialysis that shows the influence of calcium concentration in