Effect of parathyroidectomy on bone aluminum accumulation in chronic renal failure
| Autor: | Donald J. Sherrard, Dennis L. Andress, Susan M. Ott, Norma A. Maloney |
|---|---|
| Rok vydání: | 1985 |
| Předmět: |
Parathyroidectomy
Male medicine.medical_specialty medicine.medical_treatment Biopsy Urology Osteitis Fibrosa Cystica complex mixtures Bone and Bones Parathyroid Glands Postoperative Complications Osteogenesis Renal Dialysis medicine Humans Retrospective Studies Osteomalacia medicine.diagnostic_test business.industry General Medicine medicine.disease Surgery Aluminum deposition Parathyroid Hormone Chronic renal failure Kidney Failure Chronic Secondary hyperparathyroidism Hemodialysis Complication business Aluminum |
| Zdroj: | The New England journal of medicine. 312(8) |
| ISSN: | 0028-4793 |
| Popis: | In some patients with chronic renal failure, bone mineralization becomes defective after parathyroidectomy for secondary hyperparathyroidism. Because aluminum deposition in bone is associated with impaired bone formation and osteomalacia, we retrospectively studied bone-biopsy specimens from patients on hemodialysis who were not exposed to dialysate contaminated with aluminum, to determine whether aluminum accumulation on bone surfaces was enhanced by parathyroidectomy. Serial biopsy specimens taken before and after parathyroidectomy revealed an increase in the rate of aluminum deposition on the surface of mineralized bone after parathyroidectomy in each of the six patients studied. The accelerated rate of aluminum accumulation could not be explained by changes in the oral aluminum intake. The mean rate of bone formation (+/- S.E.M.) before parathyroidectomy was higher in the six patients than in six control patients who did not undergo parathyroid surgery (586 +/- 147 vs. 237 +/- 85 micron2 per square millimeter per day; P less than 0.05). After parathyroidectomy, the rate of bone formation fell to levels below normal (148 +/- 32 vs. 311 +/- 29 micron2 per square millimeter per day; P less than 0.05) but was not significantly different from the rate in the control group (319 +/- 126 micron2 per square millimeter per day). We conclude that parathyroidectomy in patients with chronic renal failure is associated with enhanced aluminum deposition on the bone surface, possibly as a result of low bone formation. Patients with secondary hyperparathyroidism who may be candidates for parathyroidectomy should be evaluated for aluminum excess before surgery, so that treatment with aluminum chelation may be considered. |
| Databáze: | OpenAIRE |
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