title: Pathogenesis of parathyroid hyperplasia in renal failure.
abstract: In chronic kidney disease, secondary hyperparathyroidism (HPTH) is characterized by parathyroid hyperplasia and enhanced synthesis and secretion of parathyroid hormone (PTH). Elevated PTH levels cause renal osteodistrophy and cardiovascular complications, with significantly increased morbidity and mortality in renal failure. The three main direct causes of renal HPTH are hypocalcemia, hyperphosphatemia and vitamin D deficiency. A link between the mechanisms controlling proliferation and hormonal production also exists in normal parathyroid cells which respond to the stimulus of chronic hypocalcemia, not only by an increase in PTH release but also with a consequent parathyroid cell proliferation. The mechanisms responsible for this link, however, remain poorly understood. In this review, we analyze the current understanding concerning the new insights into the molecular mechanisms of parathyroid hyperplasia and PTH secretion in renal failure regulated by calcium, phosphate and vitamin D.
authors.affiliation: Renal Division, San Paolo Hospital, Milan-Italy. mariocozzolino@hotmail.com
authors.forename: Mario
authors.initials: M
authors.lastname: Cozzolino
authors.forename: Diego
authors.initials: D
authors.lastname: Brancaccio
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
authors.forename: Andrea
authors.initials: A
authors.lastname: Galassi
authors.forename: Eduardo
authors.initials: E
authors.lastname: Slatopolsky
authors.forename: Adriana
authors.initials: A
authors.lastname: Dusso
mesh_terms: D000818:Animals; D002118:Calcium / Q000378:metabolism; D004032:Diet; D004305:Dose-Response Relationship, Drug; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology* / Q000473:pathology*; D006965:Hyperplasia; D010280:Parathyroid Glands / Q000187:drug effects / Q000473:pathology*; D010710:Phosphates / Q000008:administration & dosage; D051437:Renal Insufficiency / Q000150:complications*; D014511:Uremia / Q000150:complications; D014807:Vitamin D / Q000494:pharmacology
chemical_list: D010710:Phosphates; D014807:Vitamin D; D002118:Calcium