Renal Hyperparathyroidism
(2022) p.349-378- Abstract
Renal hyperparathyroidism (rHPT) is a complex and challenging disorder. It develops early in renal failure, mainly as a consequence of reduced levels of vitamin D, hypocalcemia, diminished excretion of phosphate, and inability to activate vitamin D. RHPT is associated with increased risk of fractures, cardiovascular disease and death. The diagnosis of rHPT rests on demonstrating elevated levels of parathyroid hormone, PTH. Treatment consists of supplying vitamin D, reducing phosphate intake, and treatment with active vitamin D analogs. In later stages, calcimimetics might be added. However, in rHPT, parathyroid glands grow and can become refractory to medical treatment. Patients with rHPT refractory to medical treatment should be... (More)
Renal hyperparathyroidism (rHPT) is a complex and challenging disorder. It develops early in renal failure, mainly as a consequence of reduced levels of vitamin D, hypocalcemia, diminished excretion of phosphate, and inability to activate vitamin D. RHPT is associated with increased risk of fractures, cardiovascular disease and death. The diagnosis of rHPT rests on demonstrating elevated levels of parathyroid hormone, PTH. Treatment consists of supplying vitamin D, reducing phosphate intake, and treatment with active vitamin D analogs. In later stages, calcimimetics might be added. However, in rHPT, parathyroid glands grow and can become refractory to medical treatment. Patients with rHPT refractory to medical treatment should be considered for parathyroidectomy, PTX. A close collaboration between nephrologists, endocrinologists, and endocrine surgeons is required to achieve optimal outcomes. Risks of surgery are small but not negligible. Surgery 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. Hence, a classical, systematic, standard bilateral exploration to identify all parathyroid glands, including supranumerary glands, should be carried out. The endocrine surgeon performing this operation needs to be familiar with both the pathophysiology of rHPT but also needs a detailed knowledge of parathyroid embryology and anatomy. Surgery cannot cure rHPT, but will lower PTH levels and reduce morbidity and mortality. Intraoperative measurement of PTH can be helpful; the value of preoperative imaging studies to localize parathyroid glands has not been established for PTX in rHPT.
(Less)
- author
- Almquist, Martin LU and Dotzenrath, Cornelia
- organization
- publishing date
- 2022-01-01
- type
- Chapter in Book/Report/Conference proceeding
- publication status
- published
- subject
- keywords
- Chronic kidney disease, Hyperparathyroidism, Parathyroid hormone, Parathyroidectomy, Vitamin d
- host publication
- Endocrine Surgery Comprehensive Board Exam Guide
- pages
- 30 pages
- publisher
- Springer International Publishing
- external identifiers
-
- scopus:85174754712
- ISBN
- 9783030847364
- 9783030847371
- DOI
- 10.1007/978-3-030-84737-1_14
- language
- English
- LU publication?
- yes
- id
- 8c30c9d7-8502-4b19-a5ad-cd0f72a9bc80
- date added to LUP
- 2023-12-28 14:19:13
- date last changed
- 2024-04-12 19:23:24
@inbook{8c30c9d7-8502-4b19-a5ad-cd0f72a9bc80,
abstract = {{<p>Renal hyperparathyroidism (rHPT) is a complex and challenging disorder. It develops early in renal failure, mainly as a consequence of reduced levels of vitamin D, hypocalcemia, diminished excretion of phosphate, and inability to activate vitamin D. RHPT is associated with increased risk of fractures, cardiovascular disease and death. The diagnosis of rHPT rests on demonstrating elevated levels of parathyroid hormone, PTH. Treatment consists of supplying vitamin D, reducing phosphate intake, and treatment with active vitamin D analogs. In later stages, calcimimetics might be added. However, in rHPT, parathyroid glands grow and can become refractory to medical treatment. Patients with rHPT refractory to medical treatment should be considered for parathyroidectomy, PTX. A close collaboration between nephrologists, endocrinologists, and endocrine surgeons is required to achieve optimal outcomes. Risks of surgery are small but not negligible. Surgery 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. Hence, a classical, systematic, standard bilateral exploration to identify all parathyroid glands, including supranumerary glands, should be carried out. The endocrine surgeon performing this operation needs to be familiar with both the pathophysiology of rHPT but also needs a detailed knowledge of parathyroid embryology and anatomy. Surgery cannot cure rHPT, but will lower PTH levels and reduce morbidity and mortality. Intraoperative measurement of PTH can be helpful; the value of preoperative imaging studies to localize parathyroid glands has not been established for PTX in rHPT.</p>}},
author = {{Almquist, Martin and Dotzenrath, Cornelia}},
booktitle = {{Endocrine Surgery Comprehensive Board Exam Guide}},
isbn = {{9783030847364}},
keywords = {{Chronic kidney disease; Hyperparathyroidism; Parathyroid hormone; Parathyroidectomy; Vitamin d}},
language = {{eng}},
month = {{01}},
pages = {{349--378}},
publisher = {{Springer International Publishing}},
title = {{Renal Hyperparathyroidism}},
url = {{http://dx.doi.org/10.1007/978-3-030-84737-1_14}},
doi = {{10.1007/978-3-030-84737-1_14}},
year = {{2022}},
}