Observation
Copyright ©2012 Baishideng. All rights reserved.
World J Transplant. Jun 24, 2012; 2(3): 41-45
Published online Jun 24, 2012. doi: 10.5500/wjt.v2.i3.41
New options for the management of hyperparathyroidism after renal transplantation
Walter Guillermo Douthat, Carlos Raul Chiurchiu, Pablo Ulises Massari
Walter Guillermo Douthat, Carlos Raul Chiurchiu, Pablo Ulises Massari, Bone and Mineral Metabolism Section, Renal Service, Hospital Privado, Centro Médico de Córdoba, 5016 Córdoba, Argentina
Walter Guillermo Douthat, Carlos Raul Chiurchiu, Pablo Ulises Massari, Postgraduate School of Nephrology, Catholic University of Córdoba, Fundación Nefrológica de Córdoba, 5016 Córdoba, Argentina
Author contributions: Douthat WG participated in design, acquisition of data, or analysis and interpretation of data, drafting the article, approval final version to be published; Chiurchiu CR contributes to acquisition and interpretation of data; revising the article; approval final version to be published; Massari PU contributes to analysis and interpretation of data; revising the article; approval final version to be published.
Correspondence to: Walter Guillermo Douthat, MD, PhD, Professor of Nephrology, Chief of Bone and Mineral Section, Renal Service, Hospital Privado, Centro Médico de Córdoba, Naciones Unidas 346, 5016 Córdoba, Argentina. wdouthat@hospitalprivadosa.com.ar
Telephone: +54-351-4688230 Fax: +54-351-4688844
Received: August 22, 2011
Revised: April 8, 2012
Accepted: June 1, 2012
Published online: June 24, 2012
Abstract

The persistence and severity of hyperparathyroidism (HPT) post-renal transplantation is relatively frequent and primarily associated with the timing and its magnitude in the pre-transplant period and with the presence of parathyroid adenomas. HPT after renal transplantation is clinically manifested with hypercalcemia, hypophosphatemia, bone pain, fractures, and in more serious cases with cardiovascular calcifications that affect the survival. The primary clinical objective for patients with secondary HPT after renal transplantation is to obtain a level of parathyroid hormone (PTH) adequate to the renal transplanted function and to normalize levels of calcium, phosphorus and vitamin D. In many cases during this period, the development of hypercalcemia and/or hypophosphatemia makes it necessary to take different therapeutic measures. The use of vitamin D or its analogues has been extrapolated from the management of pre-transplant HPT obtaining variable outcomes, although its use is limited by its capacity to produce hypercalcemia. Calcimimetics are drugs that have proven be effective in reducing PTH levels in patients with HPT on dialysis and has been effective in reducing up to 50% PTH levels in moderate to severe HPT in post-renal transplantation.When HPT persists after renal transplantation and does not respond to medical treatment, invasive management by percutaneous ethanol injection therapy of parathyroid glands or parathyroidectomy should be considered. The emergence of new methods for the management of HPT expands the availability of therapeutic tools for transplant patients.

Keywords: Hyperparathyroidism; Renal osteodystrophy; Renal transplantation; Percutaneous ethanol injection therapy; Parathyroidectomy; Percutaneous ethanol injection therapy