Renoprotection following treatment of secondary hyperparathyroidism with percutaneous ethanol injection in pre-dialysis patients.
What could be done for patients with chronic renal failure are marginally beneficial. Among 58 pre-dialysis patients, we found 24 of chronic glomerulonephritis (CGN) with serum creatinine >5 mg/dl and intact parathyroid hormone (i-PTH) >200 pg/ml. In this study, we determined if the residual renal function could be preserved when hyperparathyroidism was corrected by either low-dose calcitriol treatment or ethanol injection. The 58 CGN patients were divided into three groups. The first group, which comprised 11 cases with i-PTH >200 pg/ml and had parathyroid mass, were treated by ultrasonography-guided percutaneous ethanol injection therapy (PEIT). The second study group composed of 13 cases with i-PTH >200 pg/ml without parathyroid mass were treated by calcitriol 1 microg every other day. The third group made up of 34 cases with i-PTH <200 pg/ml, who did not receive calcitriol or ethanol therapy. All patients were followed up within 2 years or until dialysis. The average rate of decline in renal function (slope of reciprocal serum creatinine vs. time) was 0.0025 +/- 0.0026 dl/mg month in group 1, 0.0054 +/- 0.0024 in group 2, and 0.0067 +/- 0.0025 in group 3 (p = 0.018 in group 1 vs. group 2, p < 0.001 in group 1 vs. group 3). The declines of i-PTH, phosphorus, and alkaline phosphatase, and the increase of calcium were all significantly different between group 1 and group 3. Two cases of group 1, 6 cases of group 2, and 20 cases of group 3 entered into dialysis during this study. In conclusion, selective PEIT guided by color Doppler flow mapping is an effective therapy for treating hyperparathyroidism and protecting the residual renal function.
Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, ROC.
Han-Hsiang
HH
Chen
Yi-Chou
YC
Chen
Jui-Chi
JC
Yeh
D000279:Administration, Cutaneous; D000328:Adult; D002117:Calcitriol / Q000008:administration & dosage; D002120:Calcium Channel Agonists / Q000008:administration & dosage; D002492:Central Nervous System Depressants / Q000008:administration & dosage*; D003404:Creatinine / Q000097:blood; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000097:blood; D006435:Renal Dialysis; D016896:Treatment Outcome; D014463:Ultrasonography
D002120:Calcium Channel Agonists; D002492:Central Nervous System Depressants; D010758:Phosphorus; D000431:Ethanol; D003404:Creatinine; D002117:Calcitriol