The treatment of renal hyperparathyroidism
Almquist, Martin LU ; Isaksson, Elin LU and Clyne, Naomi LU
(2020)
In Endocrine-Related Cancer
27(1).
p.21-34
- Abstract
Renal hyperparathyroidism (rHPT) is a complex and challenging disorder. It develops early in the course of renal failure and is associated with increased risks of fractures, cardiovascular disease and death. It is treated medically, but when medical therapy cannot control the hyperparathyroidism, surgical parathyroidectomy is an option. In this review, we summarize the pathophysiology, diagnosis, and medical treatment; we describe the effects of renal transplantation; and discuss the indications and strategies in parathyroidectomy for rHPT. Renal hyperparathyroidism develops early in renal failure, mainly as a consequence of lower levels of vitamin D, hypocalcemia, diminished excretion of phosphate and inability to activate vitamin D.... (More)
Renal hyperparathyroidism (rHPT) is a complex and challenging disorder. It develops early in the course of renal failure and is associated with increased risks of fractures, cardiovascular disease and death. It is treated medically, but when medical therapy cannot control the hyperparathyroidism, surgical parathyroidectomy is an option. In this review, we summarize the pathophysiology, diagnosis, and medical treatment; we describe the effects of renal transplantation; and discuss the indications and strategies in parathyroidectomy for rHPT. Renal hyperparathyroidism develops early in renal failure, mainly as a consequence of lower levels of vitamin D, hypocalcemia, diminished excretion of phosphate and inability to activate vitamin D. Treatment consists of supplying vitamin D and reducing phosphate intake. In later stages calcimimetics might be added. RHPT refractory to medical treatment can be managed surgically with parathyroidectomy. Risks of surgery are small but not negligible. Parathyroidectomy should likely not be too radical, especially if the patient is a candidate for future renal transplantation. Subtotal or total parathyroidectomy with autotransplantation are recognized surgical options. Renal transplantation improves rHPT but does not cure it.
(Less)
- author
- Almquist, Martin
LU
; Isaksson, Elin
LU
and Clyne, Naomi
LU
- organization
- publishing date
- 2020
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Chronic kidney disease, Hyperparathyroidism, Parathyroid hormone, Parathyroidectomy, Vitamin D
- in
- Endocrine-Related Cancer
- volume
- 27
- issue
- 1
- pages
- 21 - 34
- publisher
- Society for Endocrinology
- external identifiers
-
- pmid:31693488
- scopus:85077925222
- ISSN
- 1351-0088
- DOI
- 10.1530/ERC-19-0284
- language
- English
- LU publication?
- yes
- id
- 7671655f-8720-4400-8751-888247e913b4
- date added to LUP
- 2020-02-03 10:31:28
- date last changed
- 2024-06-12 09:03:18
@article{7671655f-8720-4400-8751-888247e913b4,
abstract = {{<p>Renal hyperparathyroidism (rHPT) is a complex and challenging disorder. It develops early in the course of renal failure and is associated with increased risks of fractures, cardiovascular disease and death. It is treated medically, but when medical therapy cannot control the hyperparathyroidism, surgical parathyroidectomy is an option. In this review, we summarize the pathophysiology, diagnosis, and medical treatment; we describe the effects of renal transplantation; and discuss the indications and strategies in parathyroidectomy for rHPT. Renal hyperparathyroidism develops early in renal failure, mainly as a consequence of lower levels of vitamin D, hypocalcemia, diminished excretion of phosphate and inability to activate vitamin D. Treatment consists of supplying vitamin D and reducing phosphate intake. In later stages calcimimetics might be added. RHPT refractory to medical treatment can be managed surgically with parathyroidectomy. Risks of surgery are small but not negligible. Parathyroidectomy should likely not be too radical, especially if the patient is a candidate for future renal transplantation. Subtotal or total parathyroidectomy with autotransplantation are recognized surgical options. Renal transplantation improves rHPT but does not cure it.</p>}},
author = {{Almquist, Martin and Isaksson, Elin and Clyne, Naomi}},
issn = {{1351-0088}},
keywords = {{Chronic kidney disease; Hyperparathyroidism; Parathyroid hormone; Parathyroidectomy; Vitamin D}},
language = {{eng}},
number = {{1}},
pages = {{21--34}},
publisher = {{Society for Endocrinology}},
series = {{Endocrine-Related Cancer}},
title = {{The treatment of renal hyperparathyroidism}},
url = {{http://dx.doi.org/10.1530/ERC-19-0284}},
doi = {{10.1530/ERC-19-0284}},
volume = {{27}},
year = {{2020}},
}