Department of Surgical and Oncological Sciences, University of Palermo, School of Medicine, Palermo, Italy.
Med Hypotheses. 2011 Oct;77(4):557-9. doi: 10.1016/j.mehy.2011.06.030. Epub 2011 Jul 16.
Secondary hyperparathyroidism (HP) presenting with hypocalcemia and subsequent increased parathormone (PTH), is mainly identified in patients with chronic renal failure, which has been associated with variable degrees of bone marrow fibrosis. For suitable patients with end-stage renal disease (ESRD), kidney transplantation is recognized as the therapy of choice, being superior to dialysis in terms of quality of life and long-term mortality risk; in this regard interesting data show that increased time on dialysis prior to kidney transplantation is associated with decreased graft and patient survival. In our opinion an important and until now underestimated determinant of graft survival is the proper activity of bone marrow because of the emerging role of hematopoietic stem cells (HSC) in repair of ischemia/reperfusion (IR) damage. We postulate that in ESRD patients, who usually undergo long dialytic treatment, a myelofibrosis caused by an overt secondary HP could drastically decrease the HSC potential for IR damage repair after kidney transplant; this could irremediably lead to a delay in graft function with all related complicances. If the curative role of bone marrow-derived stem cells was confirmed by more data obtained in experimental animal models, it could be possible to try a cellular-based therapeutic approach in the management of ESRD patients which are in waiting list for a kidney transplant.
继发性甲状旁腺功能亢进症（HP）表现为低钙血症和随后甲状旁腺激素（PTH）的增加，主要发生在慢性肾衰竭患者中，与骨髓纤维化的不同程度有关。对于终末期肾病（ESRD）的合适患者，肾移植被认为是首选治疗方法，在生活质量和长期死亡率风险方面优于透析；在这方面，有趣的数据表明，在肾移植前接受透析的时间增加与移植物和患者存活率降低有关。我们认为，在 ESRD 患者中，由于造血干细胞（HSC）在修复缺血/再灌注（IR）损伤中的作用不断显现，骨髓的适当活动是移植物存活的一个重要且迄今为止被低估的决定因素。我们假设，在通常接受长期透析治疗的 ESRD 患者中，明显的继发性 HP 引起的骨髓纤维化可能会极大地降低肾移植后 HSC 修复 IR 损伤的潜力；这可能会不可逆转地导致移植物功能延迟，以及所有相关并发症。如果在实验动物模型中获得更多数据证实骨髓源性干细胞的治疗作用，那么在等待肾移植的 ESRD 患者的管理中尝试基于细胞的治疗方法是可能的。
