Indications for parathyroidectomy in end-stage renal disease
- Michael Berkoben, MD
Michael Berkoben, MD
- Associate Professor of Medicine
- Duke University Medical Center
- L Darryl Quarles, MD
L Darryl Quarles, MD
- Section Editor — Renal Osteodystrophy
- Director, Division of Nephrology
- Associate Dean for Research
- The University of Tennessee Health Science Center
Approximately 10 percent of patients with end-stage renal disease (ESRD) undergo parathyroidectomy for secondary hyperparathyroidism . This percentage has remained constant over the past 20 years despite advances in medical therapy .
This topic reviews the pathogenesis of refractory hyperparathyroidism and the indications for parathyroidectomy among patients with ESRD. The medical management of hyperparathyroidism is discussed elsewhere. (See "Management of secondary hyperparathyroidism and mineral metabolism abnormalities in adult predialysis patients with chronic kidney disease" and "Management of secondary hyperparathyroidism and mineral metabolism abnormalities in dialysis patients".)
Anatomy of the parathyroid and surgical approaches to parathyroidectomy are discussed elsewhere. (See "Parathyroidectomy in end stage renal disease".)
PATHOGENESIS OF REFRACTORY HYPERPARATHYROIDISM
A subset of patients with ESRD have marked elevations in serum parathyroid hormone (PTH) levels despite medical therapy. (See "Management of secondary hyperparathyroidism and mineral metabolism abnormalities in adult predialysis patients with chronic kidney disease" and "Management of secondary hyperparathyroidism and mineral metabolism abnormalities in dialysis patients".)
Several interrelated factors are thought to be involved in the pathogenesis of refractory hyperparathyroidism.
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- PATHOGENESIS OF REFRACTORY HYPERPARATHYROIDISM
- POTENTIAL INDICATIONS FOR PARATHYROIDECTOMY
- Symptomatic patients
- Asymptomatic patients
- Patients awaiting transplantation
- Renal transplant recipients
- PRESURGICAL EVALUATION AND TREATMENT
- Aluminum exposure
- Nonaluminum-related bone diseases
- RISKS AND OUTCOMES OF PARATHYROIDECTOMY
- SUMMARY AND RECOMMENDATIONS