Histological Changes in Parathyroid Glands in Subclinical and Clinical Renal Disease

Abstract

In an autopsy material of patients with varying degrees of renal impairment, the parathyroid glands were examined regarding glandular and parenchymal cell weights and cellular types and arrangement. The findings were related to the different stages of renal disease. The study comprised 69 cases--29 females and 40 males. Their mean age was 74 years (range 33-98 years). There was a positive relation between serum creatinine level and total parathyroid parenchymal cell weight (r=0.37, p less than 0.01) and an inverse correlation between kidney weights and parathyroid parenchymal cell weight (r=-0.24, p less than 0.05). The patients with the most advanced renal impairment had significantly higher mean total glandular and mean total parenchymal weights than those with less pronounced renal disease. Nodular arrangement and an increased number of oxyphil and transitional oxyphil cells were noted in cases with advanced histological kidney changes but normal serum creatinine levels. This nodularity as well as the frequency of oxyphil cells increased in parallel with deterioration of renal function. The two most important factors that influenced the proportion of oxyphil cells were the parenchymal cell weights and the age of the patient. It is concluded that signs of stimulation of the parathyroids are present already in early stages of renal disease, in some cases before renal dysfunction is clinically manifested.

Decreased 1,25-dihydroxyvitamin D3 receptor density is associated with a more severe form of parathyroid hyperplasia in chronic uremic patients.

“…Enlargement of the parathyroid glands and microscopic signs of glandular abnormality may be seen even in early stages of renal disease (9). With the progression of renal insufficiency, the total weight ofthe parathyroid glands may increase considerably; the degree ofthis enlargement correlates with the duration and severity of renal function impairment (9,10,16).…”

“…With the progression of renal insufficiency, the total weight ofthe parathyroid glands may increase considerably; the degree ofthis enlargement correlates with the duration and severity of renal function impairment (9,10,16). Typical histopathological findings in advanced renal hyperparathyroidism are nodularities and an increased number of oxyphil or transitional oxyphil cells (9,10,17). The hyperplastic parathyroid tissue, however, does not always show symmetrical enlargement (17).…”

“…In chronic dialysis patients with 2HPT, the parathyroid glands have been histologically classified into three patterns; those showing adenoma, diffuse hyperplasia, and nodular hyperplasia (8)(9)(10). The nodular hyperplasia may represent an advanced stage of hyperplasia and be present in more severe hyperparathyroidism ( 11 ).…”

Values of Intact Serum Parathyroid Hormone in Different Stages of Renal Insufficiency

“…It is the cells of such hyperplastic nodules which exhibits the greatest reduction in the inhibitory effects of extracellular calcium on the P"H release (3,23). Such disturbances in parathyroid cell secretion and proliferation are apparently related to the degree of hypercalcemia (21,24) but at a lesser extent, they are also present in the parathyroid glands of patients with earlier stages of renal failure (25). It remains to be established if the clinically more relevant estimate of intact serum PTH may be used to select patients for parathyroid surgery in less advanced stages of uremic HFT.…”

“…Histopathological signs of parathyroid gland stimulation have, in fact, been demonstrated already in subclinical nephropathy (25), and proliferation of bone osteoclasts, indicating excess of parathyroid hormone (PTH), occurs early in patients with kidney dysfunction (14). The clinical diagnosis of secondary HPT has been hampered by the lack of appropriate assay techniques for PTH.…”