[Efficiency of total parathyroidectomy and autotransplantation in 31 patients with uremic hyperparathyroidism].
OBJECTIVE
To analyse the efficacy of total parathyroidectomy with autotransplantation (total PTX + AT) in treating uremic secondary hyperparathyroidism and to discuss the relevant medical treatment used.


METHODS
The clinical data of 31 patients with uremic SHPT admitted into our hospital from 1996-2005 were analysed with respect to total PTX + AT.


RESULTS
The period of hemodialysis were for the patients was on the average 9.2 years. There were 22 male and 9 female with an average age of 42.4 (31 - 67) years. The clinical manifestations consisted of osteoarticular pain in 83.9%, fractures in 35.5%, soft tissue and vascular calcification in 45.2% and pruritus in 80.6%. Laboratory examination yielded the following results: haematocrit 0.25 +/- 0.04, serum Ca (2.61 +/- 0.35) mmol/L, serum P (2.14 +/- 0.31) mmol/L, plasma total alkaline phosphatase (AKP) (885 +/- 335) U/L and parathyroid hormone (iPTH) (1811 +/- 879) ng/L (700 - 2500 ng/L). Cervical ultrasonography and/or emission computed tomography showed 2 - 4 hyperplastic glands. All of the patients showed no response to medical treatment including vitamin D. Total PTX + AT was performed on the 31 cases. Clinical symptoms and signs markedly improved after operation in 1 to 2 weeks. However, fracture and ectopic calcification showed no improvement. Plasma iPTH decreased rapidly (< 200 ng/L) postoperatively in 1 to 2 days. Serum Ca and P returned to normal. AKP was corrected in 1 to 3 months.


CONCLUSIONS
Total parathyroidectomy with autotransplantation is an effective treatment for severe uremic secondary hyperparathyroidism patients.
Hu
Jian-ming
JM
Division of Nephrology, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.
Wu
Hong-fei
HF
Wang
Xiao-yun
XY
Yu
Xiang-bao
XB
Zhao
Yi-hua
YH
Shen
Xia
X
Liu
Jia
J
Sun
Bin
B
Xing
Chang-ying
CY
Yang
Jun-wei
JW
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D006435:Renal Dialysis; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D014511:Uremia / Q000150:complications