Histological changes in parathyroid glands in subclinical and clinical renal disease. An autopsy investigation.

In an autopsy material of patients with varying degrees of renal impairment, the parathyroid glands were examined regarding glandular and parenchymal cell weights and cellular types and arrangement. The findings were related to the different stages of renal disease. The study comprised 69 cases--29 females and 40 males. Their mean age was 74 years (range 33-98 years). There was a positive relation between serum creatinine level and total parathyroid parenchymal cell weight (r=0.37, p less than 0.01) and an inverse correlation between kidney weights and parathyroid parenchymal cell weight (r=-0.24, p less than 0.05). The patients with the most advanced renal impairment had significantly higher mean total glandular and mean total parenchymal weights than those with less pronounced renal disease. Nodular arrangement and an increased number of oxyphil and transitional oxyphil cells were noted in cases with advanced histological kidney changes but normal serum creatinine levels. This nodularity as well as the frequency of oxyphil cells increased in parallel with deterioration of renal function. The two most important factors that influenced the proportion of oxyphil cells were the parenchymal cell weights and the age of the patient. It is concluded that signs of stimulation of the parathyroids are present already in early stages of renal disease, in some cases before renal dysfunction is clinically manifested.