Evaluation of parathyroid hyperplasia by ultrasonographic examination in patients with end-stage renal failure before and at initiation of dialysis.
Secondary hyperparathyroidism (2HPT), which is related to renal osteodystrophy (ROD), may occur in patients in the comparatively early stage of chronic renal failure (CRF). Secondary hyperparathyroidism patients with parathyroid hyperplasia showed resistance to vitamin D(3) treatment during long-term dialysis. At present, evaluation by ultrasonography is considered to be useful for confirming parathyroid hyperplasia. There are no clinical data associated with imaging evaluation of 2HPT in CRF patients. In the present study, the relationship among clinical and biochemical data, and parathyroid hyperplasia by ultrasonography, was evaluated in 12 patients (six males and six females) with end-stage renal failure (ESRF) before and at initiation of dialysis. Five patients showed an enlargement of parathyroid glands in ultrasonography. Levels of serum-intact parathyroid hormone (PTH) in patients with parathyroid hyperplasia (positive group) were significantly higher than in those without hyperplasia (negative group; 97.6 +/- 36.65 vs 17.4 +/- 4.45 pmol/L; P < 0.05). The levels of intact PTH were above 35.0 pmol/L in all five patients with hyperplasia. All patients in the positive group had never taken vitamin D(3) supplements. Calcium-containing phosphate binders were not prescribed before the present study, except in one patient. Parathyroid hyperplasia caused by 2HPT was recognized in patients before and at initiation of dialysis in this study. It appears that untreated 2HPT in CRF patients may progress to advanced 2HPT in ESRF before and/or after the early stage of dialysis. The levels of serum intact PTH are useful in predicting parathyroid hyperplasia.
Hamada
Chieko
C
Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan.
Fukui
Mitsumine
M
Sakamoto
Tomoko
T
Koizumi
Michiko
M
Ishiguro
Chizuru
C
Osada
Shiwori
S
Shou
Ichiyu
I
Hayashi
Kayo
K
Tomino
Yasuhiko
Y
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D002119:Calcium Carbonate / Q000627:therapeutic use; D002762:Cholecalciferol / Q000627:therapeutic use; D003956:Dialysis; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006965:Hyperplasia; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging*; D010281:Parathyroid Hormone / Q000097:blood; D018615:Ultrasonography, Doppler, Color; D014815:Vitamins / Q000627:therapeutic use
D015415:Biomarkers; D010281:Parathyroid Hormone; D014815:Vitamins; D002762:Cholecalciferol; D000469:Alkaline Phosphatase; D002119:Calcium Carbonate; D002118:Calcium