Okada Manabu, Tominaga Yoshihiro, Hiramitsu Takahisa, Ichimori Toshihiro
Department of Transplantation and Endocrine Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 4668650, Japan.
Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan.
World J Surg. 2018 Feb;42(2):425-430. doi: 10.1007/s00268-017-4164-7.
We occasionally experience cases of severe secondary hyperparathyroidism (SHPT) that require parathyroidectomy (PTX) despite undergoing short-term renal replacement therapy (RRT). Because the characteristics of such cases have never been discussed, we aimed to elucidate the pathophysiology of severe SHPT after short-term RRT by retrospectively analyzing clinical data.
A total of 1013 patients with severe SHPT underwent PTX between January 2007 and April 2016 at Nagoya Daini Red Cross Hospital. Of these patients, 570 underwent RRT for ≥10 years (long RRT group) and 23 for ≤1 year (short RRT group). We retrospectively investigated and compared patient characteristics, preoperative data, subjective symptoms, and bone lesion incidence between the two groups.
A higher proportion of subjects with congenital or hereditary diseases as primary disease for chronic kidney disease (CKD) (21.7% (5/23) vs. 6.3% (36/570); P = 0.016) and longer predialysis period (21.2 ± 14.0 vs. 10.1 ± 9.2 years; P < 0.001) were observed in the short RRT group than in the long RRT group. Furthermore, lower serum calcium and phosphate levels, heavier parathyroid glands, and severe bone lesions were observed in the short RRT group than in the long RRT group.
Severe SHPT after short-term RRT appeared to occur because of long-term CKD before initiating RRT. Therefore, treating mineral and bone disorders during the early CKD stage might prevent severe SHPT development before initiating RRT.
我们偶尔会遇到一些严重继发性甲状旁腺功能亢进症（SHPT）的病例，尽管这些患者接受了短期肾脏替代治疗（RRT），但仍需要进行甲状旁腺切除术（PTX）。由于此类病例的特征从未被讨论过，我们旨在通过回顾性分析临床数据来阐明短期RRT后严重SHPT的病理生理学。
2007年1月至2016年4月期间，共有1013例严重SHPT患者在名古屋第二红十字医院接受了PTX。其中，570例接受RRT≥10年（长期RRT组），23例接受RRT≤1年（短期RRT组）。我们回顾性调查并比较了两组患者的特征、术前数据、主观症状和骨病变发生率。
与长期RRT组相比，短期RRT组中患有先天性或遗传性疾病作为慢性肾脏病（CKD）原发性疾病的患者比例更高（21.7%（5/23）对6.3%（36/570）；P = 0.016），且透析前病程更长（21.2±14.0对10.1±9.2年；P < 0.001）。此外，与长期RRT组相比，短期RRT组的血清钙和磷水平更低，甲状旁腺更重，骨病变更严重。
短期RRT后的严重SHPT似乎是由于开始RRT前长期存在CKD所致。因此，在CKD早期阶段治疗矿物质和骨代谢紊乱可能会在开始RRT前预防严重SHPT的发生。
