Department of Clinical Sciences Lund, Department of Surgery Section of Endocrine and Sarcoma Lund, Skåne University Hospital, Lund University, Lund, Sweden.
Department of Clinical Sciences Malmö, Urology Malmö, Faculty of Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.
Endocr Relat Cancer. 2020 Jan;27(1):R21-R34. doi: 10.1530/ERC-19-0284.
Renal hyperparathyroidism (rHPT) is a complex and challenging disorder. It develops early in the course of renal failure and is associated with increased risks of fractures, cardiovascular disease and death. It is treated medically, but when medical therapy cannot control the hyperparathyroidism, surgical parathyroidectomy is an option. In this review, we summarize the pathophysiology, diagnosis, and medical treatment; we describe the effects of renal transplantation; and discuss the indications and strategies in parathyroidectomy for rHPT. Renal hyperparathyroidism develops early in renal failure, mainly as a consequence of lower levels of vitamin D, hypocalcemia, diminished excretion of phosphate and inability to activate vitamin D. Treatment consists of supplying vitamin D and reducing phosphate intake. In later stages calcimimetics might be added. RHPT refractory to medical treatment can be managed surgically with parathyroidectomy. Risks of surgery are small but not negligible. Parathyroidectomy should likely not be too radical, especially if the patient is a candidate for future renal transplantation. Subtotal or total parathyroidectomy with autotransplantation are recognized surgical options. Renal transplantation improves rHPT but does not cure it.
肾性甲状旁腺功能亢进症(rHPT)是一种复杂且具有挑战性的疾病。它在肾衰竭早期发展,并与骨折、心血管疾病和死亡风险增加相关。该病采用药物治疗,但当药物治疗无法控制甲状旁腺功能亢进时,甲状旁腺切除术是一种选择。在这篇综述中,我们总结了其病理生理学、诊断和药物治疗;描述了肾移植的影响;并讨论了 rHPT 甲状旁腺切除术的适应证和策略。肾性甲状旁腺功能亢进症在肾衰竭早期就会发生,主要是由于维生素 D 水平降低、低钙血症、磷酸盐排泄减少以及无法激活维生素 D。治疗包括补充维生素 D 和减少磷酸盐摄入。在后期阶段可能会添加钙敏感受体激动剂。对药物治疗有抵抗的 rHPT 可以通过甲状旁腺切除术进行手术治疗。手术风险很小,但并非可以忽略不计。甲状旁腺切除术不应过于激进,特别是如果患者是未来肾移植的候选者。次全或全甲状旁腺切除术加自体移植是公认的手术选择。肾移植可以改善 rHPT,但不能治愈它。