Parathyroidectomy slows renal function decline in patients with primary hyperparathyroidism

Liang, Ching‐Chung; Yeh, Hung‐Chieh; Lo, Yu Chieh; Yen, Tzung‐Hai; Tsai, Hsiu-Chen; Hsu, Sheng-Pang; Kuo, Chin‐Chi

doi:10.1007/s40618-020-01369-4

Cited by 6 publications

(6 citation statements)

References 40 publications

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“…Approximately 12% (31) to 30.4% (32) PHPT patients are combined with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ). Liang CC et al (33) reported that PTX could slow the decline of eGFR, but another study did not find PTX could reverse renal dysfunction (32). Scarce data were available to evaluate the renal function of PHPT patients after treatment.…”

Section: Discussionmentioning

confidence: 99%

Bone Turnover Markers in Response to Ultrasound-Guided Microwave Ablation for Primary Hyperparathyroidism

Yuan

Chu

et al. 2021

Front. Endocrinol.

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ObjectiveTo assess the efficacy and safety of ultrasound-guided microwave ablation (MWA) in the treatment of primary hyperparathyroidism (PHPT), and to investigate whether MWA can improve the bone turnover and renal function.MethodsA total of 20 consecutive PHPT patients with 21 parathyroid lesions treated with MWA in our center from May 2019 to March 2021 were recruited in this study. Serum parathyroid hormone (PTH), calcium and phosphorus levels before MWA and at 20 minutes, 4 hours, 1 day, 3 months, 6 months and 12 months after MWA were measured. Bone turnover biomarkers, renal function and lesion volume with volume reduction rate (VRR) before MWA and at the last follow-up were compared. Any complication related with MWA was evaluated. The technical and clinical success rates of MWA in the treatment of PHPT were calculated. Clinical success was defined as normal serum PTH and calcium without PHPT-associated manifestations at more than 6 months after ablation. Technical success was defined as complete ablation indicated by immediate postoperative contrast-enhanced ultrasound.ResultsThe serum PTH, calcium and phosphorus levels at their respective follow-up time points dropped significantly after MWA (P <0.05). The volume of parathyroid lesions at the final examination was significantly reduced, compared with pre-ablation volume (P <0.001), with a median VRR reaching 89%. The technical and clinical success rates were 100% and 63.6%, respectively. Substantial changes of bone turnover biomarkers were observed before and after MWA (P <0.05), but the differences in renal function were not statistically significant. No major complications were reported in all cases. Pre-MWA serum PTH, lesion volume, maximum diameter of lesion and ablation time were significantly different between patients with successful and failed MWA.ConclusionsPHPT can be effectively and safely treated by ultrasound-guided MWA, as proven by drop in serum PTH and reduction in the volume of parathyroid adenomas. Besides, MWA can impede bone remodeling to suppress hyperparathyroidism in the condition of PHPT.

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Section: Discussionmentioning

confidence: 99%

Bone Turnover Markers in Response to Ultrasound-Guided Microwave Ablation for Primary Hyperparathyroidism

Yuan

Chu

et al. 2021

Front. Endocrinol.

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“…In PHPT patients with a coexisting renal impairment, the results of renal function after PTX are still controversial. Although some retrospective studies show benefits to kidney function of patients undergoing PTX [4,10,17], other studies reported that PTX is associated with acute and permanent renal impairment in PHPT patients [18][19][20]. A prospective study of 494 patients undergoing PTX for PHPT reported a robust eGFR decrease of 21 mL/min/1.73 m 2 in the acute period, and 48.8% of patients fulfilled the KDIGO criteria for AKI [19].…”

Section: Discussionmentioning

confidence: 99%

“…A combination of factors, including old age, preoperative comorbidities (hypertension and CHD), kidney cysts, and recurrent hyperparathyroidism, may be responsible for post-operative renal dysfunction in this patient. A recent study suggested that the beneficial effect of PTX is more pronounced in patients with age < 65 years, non-CKD, and those without hypertension [10]. These facts raise a series of questions: Whether each patient with the diagnosis of PHPT requires PTX?…”

Section: Discussionmentioning

confidence: 99%

“…Chronic kidney disease (CKD) is a major public health concern worldwide, leading to adverse outcomes of kidney failure [8,9]. Considering the insults including nephrocalcinosis, hypercalciuria, tubulointerstitial inflammation [10], CKD is also recognized as a common complication in patients with PHPT, accounting for 13-19% of this population. However, there are few reports on PHPT patients with previously diagnosed CKD.…”

Section: Introductionmentioning

confidence: 99%

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A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease

Li¹,

Chen²,

Meng³

2021

SJCM

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Background: Parathyroidectomy (PTX) is the definitive treatment of primary hyperparathyroidism (PHPT) for symptomatic patients. PTX for hyperparathyroidism is associated with the risk of recurrence; however, this has been mostly demonstrated in chronic kidney disease (CKD) patients with secondary hyperparathyroidism. The recurrent risk of hyperparathyroidism and renal outcomes after PTX in patients with PHPT has been rarely reported. Patient: In this article, we report a case of a 70-year-old man with previously diagnosed CKD, underwent a subtotal PTX for asymptomatic primary hyperparathyroidism induced by parathyroid hyperplasias. The PTX appears to resolve the calcium disturbance in this patient. However, at three months after the surgery, the diagnosis of recurrent hyperparathyroidism was made, based on a remarkably increased level of parathyroid hormone from 42.12 pg/ml to 270.9 pg/ml. Over 2 years of follow-up, his renal function, as evaluated by serum creatinine levels, fluctuated modestly, but persist at a preoperative level of renal impairment. These data indicate that this patient with asymptomatic PHPT has experienced recurrent hyperparathyroidism with persistent renal dysfunction after PTX. Conclusion: The recurrent hyperparathyroidism after PTX in PHPT patients with a coexisting renal impairment appears more common than might be anticipated. We recommend that if hyperparathyroidism recurs or exacerbates by the persistent renal dysfunction after PTX, the potential benefits of PTX should be reconsidered and carefully weighed against the possible surgical risks.

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“…In our opinion, this conclusion underestimates the role of acute and permanent renal impairment after PTX, which is clearly shown in our results. Other authors have small and selected case series suggesting that parathyroidectomy slows the decline in kidney function but demonstrating an almost significant long-term decline in the eGFR [39].…”

Section: Plos Onementioning

confidence: 99%

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Parathyroidectomy slows renal function decline in patients with primary hyperparathyroidism

Cited by 6 publications

References 40 publications

Bone Turnover Markers in Response to Ultrasound-Guided Microwave Ablation for Primary Hyperparathyroidism

Bone Turnover Markers in Response to Ultrasound-Guided Microwave Ablation for Primary Hyperparathyroidism

A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease

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