[Disorders of parathyroid function in patients on regular dialysis therapy and after kidney transplantation].

Abstract

BACKGROUND:

Parathyroids dysfunction is a key disorder in the spectrum of renal osteopathy, occurring after renal transplantation and, occasionally, after parathyroidectomy. In our subjects, dysfunction is understood as plus or minus activity.

METHODS AND RESULTS:

Parathyroidectomy as the primary procedure was performed in 179 patients for all types of hyperparathyrodism. In 70% of cases the secondary hyperparathyroidism was treated, believed to be the most severe condition. Present assessment was focused on postoperative parathyroid hormone levels (pg/ml) in three groups of patients (n = 92). Group 1 with parathyroid gland autoimplants following total parathyroidectomy; Group 2 after partial or subtotal surgery; Group 3 after autologous implantation of cryopreserved parathyroid glands in severe hypoparathyroidism. Group 1 (32 dialysis and 9 non-dialysed patients): 228.9 vs 85.9 pg/ml; ns; hypofunction in 50% and in 33% respectively, afunction in 12.5% of dialysed patients, in non-dialysed patients it was not detected. Group 2 (25 dialysis and 24 non-dialysed patients): 603.3 vs 169.8 (pg/ml); p = 0.01; hypofunction in 16% and in 8% respectively, afunction was not detected. Complete groups 1 and 2 of patients: 197.5 vs 382.3 pg/ml (p = 0.0016). Dialysed patients in Group 1 and 2: 228.9 vs 603.3 pg/ml (p = 0.007); non-dialysed patients: 85.9 vs 169.8 pg/ml; ns. Group 3 (15 dialysed patients): 63.0; hypofunction and afunction in 40%. This group (63.0 pg/ml) vs Groups 1 and 2 of dialysed patients (p = 0.031 and 0.0004), respectively. Basic laboratory findings before operations of tertiary hyperparathyroidism were shown.

CONCLUSIONS:

After total parathyroidectomy with parathyroids autoimplantation, parathyroid hormone is acceptable to dialysis and non-dialysis patients. Partial parathyroidectomy prevents development of hypoparathyroidism. It is associated, however, with a risk because of hyperparathyrodism recurrence. Cryopreserved autologous parathyroids reach lower parathyroid levels compared with "fresh" parathyroid tissue autoimplants. Parathyroidectomy after successful renal transplantation may be indicated.

• Authors: I Sotorník, P Bubenícek, M Adamec, L Karasová, C Povýsil, J Skibová
• Journal: Casopis lekaru ceskych (Cas Lek Cesk) Vol. 142 Issue 4 Pg. 229-34 ( 2003) ISSN: 0008-7335 [Print] Czech Republic
• Vernacular Title: Poruchy funkce prístítných tĕlísek u nemocných v pravidelném dialyzacním lécení a po transplantaci ledviny.
• PMID: 12841126 (Publication Type: English Abstract, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Aged
• Female
• Humans
• Hyperparathyroidism, Secondary (etiology, prevention & control, surgery)
• Hypoparathyroidism (etiology, therapy)
• Kidney Transplantation
• Male
• Middle Aged
• Parathyroid Glands (transplantation)
• Parathyroidectomy
• Renal Dialysis (adverse effects)
• Transplantation, Autologous