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Cas Lek Cesk. 2003;142(4):229-34.

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

[Article in Czech]

Author information

  • 1Klinika nefrologie IKEM, Praha. ivo.sotornik@medicon.cz

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.

PMID:
12841126
[PubMed - indexed for MEDLINE]
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