Comparison of microwave ablation treatments in patients with renal secondary and primary hyperparathyroidism

Abstract

Purpose: Microwave ablation (MWA) is feasible for severe renal secondary hyperparathyroidism (SHPT) and primary hyperparathyroidism (PHPT) patients ineligible for parathyroidectomy (PTX).Here we compared the clinical manifestations and characteristics of parathyroid glands in these two groups, and summarized the techniques, safety and efficacy of MWA. Methods: Baseline clinical characteristics, ablation-related techniques, adverse events/complications, and efficacy were recorded. Results: In SHPT group, malnutrition, cardiovascular/pulmonary complications, and abnormal bone metabolism were severe. SHPT patients had more hyperplastic parathyroid glands. The volume of each gland was smaller, and the time of ablation for a single parathyroid was shorter in the SHPT group, although there were no significant differences compared with patients in the PHPT group. Three patients in both groups had recurrent laryngeal nerve injuries and all recovered, except for one SHPT patient. By the end of follow-up, serum iPTH levels had decreased from 2400.26 ± 844.26 pg/mL to 429.39 ± 407.93 pg/mL (p < .01) in SHPT and from 297.73 ± 295.32 pg/mL to 72.22 ± 36.51 pg/mL in PHPT group (p < .01). Hypocalcemia was more common (p < .001) and serum iPTH levels were prone to rebound in SHPT patients after MWA. Conclusion: MWA can be reserved for those who had high surgical risks because of less invasiveness. Injuries of recurrent laryngeal nerves should be noticed. The health status, perioperative, and intraoperative procedures were more complicated and all parathyroids found by ultrasound should be ablated completely in SHPT patients.

Estrogen and estrogen receptors in kidney diseases

“…Parathyroidectomy (PTX) is considered when patients develop drug resistance or side effects [317]. Recent studies also confirmed the feasibility and efficacy of microwave ablation treatment for patients ineligible for PTX [318,319]. Therefore, more studies are warranted to evaluate whether there is an additional benefit of adding estrogen or SERMs to the established treatment regimen.…”

“…Potential etiologies include platelet dysfunction, dysfunctional von Willebrand factor, decreased production of thromboxane, uremic toxins, and anemia [322,323]. The bleeding tendency in uremic patients was further complicated or exacerbated by their comorbidities and medications (e.g., hypertension, atrial fibrillation with warfarin therapy, cerebrovascular disease with anticoagulants) [318,[324][325][326]. For patients who were refractory to routine interventions for uremic bleeding, conjugated estrogens might be another option [327][328][329].…”

Evaluation of efficacy of ultrasound‐guided microwave ablation in primary hyperparathyroidism

“…It can also lead to small local lesions and a large systemic effect 7 . Patients with PHPT usually develop hypercalcemia 5 . Its main clinical manifestations are complex, with kidney stones being the most common.…”

“… 4 Moreover, the incidence of PHPT in women is three times higher than that in men, and the incidence increases with age. 5 , 6 …”

“… 7 Patients with PHPT usually develop hypercalcemia. 5 Its main clinical manifestations are complex, with kidney stones being the most common. It can cause osteoporosis and fracture, and can also cause calcification of blood vessels and soft tissues, increasing the risk of other diseases, and sometimes even endangers life.…”