Parathyroid responsiveness during hypocalcemia after total parathyroidectomy and autotransplantation in patients with renal hyperparathyroidism
| Autor: | José Gilberto H. Vieira, Patricia Dreyer, Ilda S. Kunii, Monique Nakayama Ohe, Lívia Marcela Santos, Rodrigo Oliveira Santos, Aluizio B. Carvalho |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Urology Transplantation Autologous Peritoneal dialysis Parathyroid Glands 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal medicine medicine Humans Renal Insufficiency Chronic Kidney transplantation Calcium metabolism Parathyroidectomy Hyperparathyroidism Sodium bicarbonate Hypocalcemia business.industry General Medicine Middle Aged medicine.disease Transplantation Endocrinology chemistry Parathyroid Hormone 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Female Hyperparathyroidism Secondary Hemodialysis business hormones hormone substitutes and hormone antagonists Kidney disease |
| Zdroj: | Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia. 38(2) |
| ISSN: | 2175-8239 |
| Popis: | Introduction: Hyperparathyroidism is a frequent complication of chronic kidney disease (CKD). Total parathyroidectomy (PTX) with parathyroid tissue autotransplantation (AT) is a treatment option in those individuals that do not respond to clinical management. Objective: To evaluate grafted parathyroid tissue response during induced hypocalcemia among CKD patients who underwent total PTX with AT. Methods: Eighteen patients with renal hyperparathyroidism were submitted to total PTX with parathyroid AT selected by stereomicroscopy between April and October 2008. Eleven (eight with successful kidney transplantation, 2 in peritoneal dialysis and 1 in hemodialysis) were clinically stable and eligible for testing. Hypocalcemia was induced using sodium bicarbonate infusion in 5 healthy controls and in patients 6-12 months after surgery. Results: Among controls, hypocalcemia elicited a major rise in intact PTH (iPTH) levels 4 minutes after bicarbonate infusion. In patients, a significant decrease in ionized calcium concentration was observed [from 1.17 ± 0.12 to 1.09 ± 0.11 mean (± SE) mmol/L] in the 4th minute (p < 0.001) illustrating the nadir point. In the 10thminute, ionized calcium did not show a statistical increase compared to the 4th minute (p = 0.451). The iPTH levels ranged from 34.8 ± 18.6 to 34.1 ± 18.8 pg/mL (similar values between base line and 4thminute p = 0.087) and did not change in the 10th minute (33.3 ± 19,6 pg/ mL p = 0.693). Conclusion: Among CKD patients tested 6-12 months after surgery, grafted parathyroid tissue revealed a blunted secretory capacity during bicarbonate induced hypocalcemia with no changes in iPTH levels |
| Databáze: | OpenAIRE |
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