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Pathogenesis and management of hyperparathyroidism in end‐stage renal disease and after renal transplantation
Author(s) -
Elder Grahame J
Publication year - 2001
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1046/j.1440-1797.2001.00038.x
Subject(s) - medicine , secondary hyperparathyroidism , hyperparathyroidism , calcitriol , transplantation , dialysis , parathyroid hormone , vitamin d and neurology , osteoporosis , bone disease , renal osteodystrophy , end stage renal disease , urology , bone remodeling , kidney transplantation , endocrinology , kidney disease , disease , calcium
SUMMARY: Secondary hyperparathyroidism is an adaptive response to progressive loss of renal function so as to maintain calcium and phosphate homeostasis, 1,25‐dihydroxyvitamin D 3 levels and normal bone turnover, despite skeletal resistance to parathyroid hormone. As feedback regulation fails, complications of parathyroid overactivity develop, and by the commencement of dialysis abnormal bone histology is present in almost all patients, with hyperparathyroid changes most commonly found. Post transplantation, persisting hyperparathyroidism predisposes to osteoporosis. The risk of bone disease is reduced by early, carefully targeted dietary measures and suppressive therapy with calcitriol and calcium‐based phosphate binders, while newer therapies include bisphosphonates and calcimimetics. Timely surgical intervention is necessary in some patients.