| Series |
Renal Osteodystrophy, Up-To-Date |
| Title |
Timing of mass reduction of enlarged parathyroid glands for treatment of advanced renal hyperparathyroidism |
| Author |
Takatoshi Kakuta |
Department of Internal Medicine, Tokai University School of Medicine |
| Author |
Katsuya Uemura |
Department of Internal Medicine, Tokai University School of Medicine |
| [ Summary ] |
Marked parathyroid hyperplasia is a characteristic feature of severe hyperparathyroidism in patients requiring chronic hemodialysis. For the management of these patients, intravenous calcitriol, vitamin D analogues, pulse therapy and calcium free phosphate binders have been developed. However, most of these patients become resistant to conservative therapies. For the timing of parathyroidectomy (PTx) or percutaneous ethanol injection therapy (PEIT), it is important to decide on the limitations of conservative therapy. For those patients whose serum intact-PTH > 300 pg/ml. Ca > 10.2 mg/dl, P > 6.0 mg/dl and who had an enlarged PTG (i.e. the longest diameter exceeding 1.0 cm) at least after conservative therapy, reduction of the enlarged parathyroid glands is needed to control parathyroid hormone secretion (Refer to K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease). Now it is necessary to accurately determine appropriate levels and adjust Ca, P and PTH levels for each patient. |