Cunningham J
Department of Nephrology, Royal London Hospital and Medical College, UK.
Curr Opin Nephrol Hypertens. 1993 Jul;2(4):552-7. doi: 10.1097/00041552-199307000-00005.
It has become increasingly evident that clear-cut disturbances of bone and mineral metabolism develop early in renal failure. Among these disturbances, hyperparathyroidism is well documented and is usually asymptomatic at that early stage. It is now accepted that early therapy using phosphate restriction, through diet and calcium-containing phosphate binders, and 1 alpha-hydroxylated vitamin D analogues is an effective means of preventing or even reversing hyperparathyroidism in early renal failure. The response to these therapies is both functional (reduced parathyroid hormone secretion) and structural (prevention of parathyroid gland hyperplasia). Parathyroid hyperplasia is largely irreversible; prevention is therefore important and can be achieved initially by a combination of diet and calcium-containing phosphate binders, with later addition of calcitriol or alfacalcidol if parathyroid hormone control cannot be achieved or sustained.
越来越明显的是，在肾衰竭早期就会出现明显的骨与矿物质代谢紊乱。在这些紊乱中，甲状旁腺功能亢进有充分的文献记载，且在早期通常无症状。现在人们公认，通过饮食限制磷以及使用含钙的磷结合剂和1α-羟化维生素D类似物进行早期治疗，是预防甚至逆转早期肾衰竭甲状旁腺功能亢进的有效方法。对这些治疗的反应既有功能性的（甲状旁腺激素分泌减少），也有结构性的（预防甲状旁腺增生）。甲状旁腺增生在很大程度上是不可逆的；因此，预防很重要，最初可通过饮食和含钙的磷结合剂联合来实现，如果无法实现或维持甲状旁腺激素的控制，随后可添加骨化三醇或阿法骨化醇。
