Persistent hyperparathyroidism after renal transplantation
- Sri G Yarlagadda, MD
Sri G Yarlagadda, MD
- Associate Professor
- University of Kansas Medical Center
- Thomas Nickolas, MD, MS
Thomas Nickolas, MD, MS
- Associate Professor of Medicine
- Training Program Directory, Nephrology
- Columbia University Medical Center, Department of Medicine, Nephrology
- 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
Renal transplant recipients are vulnerable to persistent hyperparathyroidism and other disorders of mineral and bone metabolism associated with chronic kidney disease (CKD).
This topic reviews recommendations regarding monitoring and treatment of hyperparathyroidism, hypercalcemia, and hypophosphatemia among renal transplant candidates and recipients.
Other bone disorders that affect renal transplant recipients, including osteoporosis and osteonecrosis, are discussed elsewhere. (See "Bone disease after renal transplantation".)
The pathogenesis of metabolic bone disease and the treatment of hyperparathyroidism in nontransplant CKD patients are discussed elsewhere. (See "Overview of chronic kidney disease-mineral and bone disorder (CKD-MBD)" and "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".)
Most patients with chronic kidney disease (CKD) develop some degree of secondary hyperparathyroidism by the time they initiate renal replacement therapy (RRT). Secondary hyperparathyroidism occurs in response to multiple abnormalities that initially stem from decreased glomerular filtration rate (GFR) . The pathophysiology of secondary hyperparathyroidism in CKD patients is discussed at length elsewhere. (See "Overview of chronic kidney disease-mineral and bone disorder (CKD-MBD)", section on 'Overview'.)
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- CLINICAL MANIFESTATIONS
- Allograft loss
- Before transplantation
- After transplantation
- - Monitoring after transplant
- - Hypercalcemia
- - Hypophosphatemia
- - Increased parathyroid hormone without hypercalcemia
- SUMMARY AND RECOMMENDATIONS