Total parathyroidectomy and renal function in patients with chronic renal failure.

5 patients with nonterminal renal failure who underwent total parathyroidectomy at Sydney Hospital over a 4-year period showed significant postoperative deterioration in renal function. In 4 of these patients, this deterioration occurred at a time when they were receiving supplements of calcium and 1,25-dihydroxyvitamin D3 but when close monitoring failed to show any evidence of hypercalcemia. In 1 patient the deterioration in renal function was clearly associated with hypercalcemia. We suggest that parathyroidectomy in nondialyzed patients be reserved for those with severe symptomatic hyperparathyroidism and that wherever possible the need for large doses of calcium and vitamin D be avoided.