title: Secondary Hyperparathyroidism in End-Stage Renal Disease: No Longer a Matter for Surgeons?
abstract: Hyperphosphatemia, hypocalcemia and vitamin D deficiency are the main factors involved in the pathogenesis of secondary hyperparathyroidism (SHPT). Moreover, the skeletal resistance to parathyroid hormone is not only a high-turnover bone accompanying SHPT, but may also play a crucial role in the onset of low-turnover bone disease in uremia. However, a growing body of evidence suggests that other hormones play a key role in this disease, such as fibroblast growth factor 23, Klotho and sclerostin. SHPT causes both bone-associated and non-skeletal consequences, including cardiovascular calcifications. Furthermore, vitamin D and calcium (Ca)-containing phosphate binders may increase Ca load. Anyway, the rate of parathyroidectomy in end-stage renal disease has greatly decreased during the last decade. Is there any room left for surgeons?
authors.affiliation: Renal Division and Laboratory of Experimental Nephrology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cozzolino
authors.forename: Francesca
authors.initials: F
authors.lastname: Elli
authors.forename: Stefano
authors.initials: S
authors.lastname: Carugo
authors.forename: Paola
authors.initials: P
authors.lastname: Ciceri
mesh_terms: D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications*; D016105:Parathyroidectomy / Q000706:statistics & numerical data*
chemical_list: D006728:Hormones