Serum calcium as an early indicator for surgical treatment of hyperparathyroidism after renal transplantation

Abstract

In an attempt to find out if a particular group of patients with hyperparathyroidism after renal transplantation (HRT) are at risk of developing complications, 14 patients with overt untreated HRT who had at least 1 serum calcium determination ≥ 12 mg/100 ml were evaluated and compared retrospectively with 11 normocalcemic transplant recipients at 6 and 30± 8 months after successful renal allografting. Serum calcium was ≥ 12 mg/100 ml within 6 months of transplantation in 13 of the 14 HRT patients. At 6 months significant differences were found between HRT and controls in mean serum calcium (11.6 versus 9.2 mg/100 ml) and alkaline phosphatase (228 versus 120 U/l). At 30±8 months differences were found in serum calcium (10.2 versus 9.4 mg/100 ml), phosphate (2.8 versus 4.8 mg/100 ml), and alkaline phosphatase (180 versus 88 U/l). Serum creatinine levels were similar in the 2 groups. A significant correlation was found between early and late determinations of alkaline phosphatase when all 25 patients were studied as a single group (r=0.72, p<0.001). Bone pain and/or radiological evidence of hyperparathyroid bone disease were significantly associated with HRT (8 versus 1 and 7 versus 0, respectively). A higher but not significant incidence of vascular calcifications (5 versus 1) and acute pancreatitis (2 versus 0) was found in HRT. Patients who develop moderate to severe HRT as defined by at least 1 serum calcium determination ≥ 12 mg/100 ml do so within 6 months of renal transplantation, have increased morbidity, particularly involving the skeleton, and might benefit from early subtotal parathyroidectomy.

Surgical treatment of tertiary hyperparathyroidism after renal transplantation: A 31-year experience in a single institution

“…tHPT can cause serious problems, including hypercalcaemia, osteitis fibrosa cystica, osteoporosis leading to increased risk of fracture, soft tissue calcification, bone pain, myopathy with muscular weakness, tendon rupture, anaemia (refractory to erythropoietin), arterial hypertension, and hypercalciuria that increases the risk of kidney stone disease, which is particularly deleterious in a renal graft [4,[6][7][8][9][10][11][12].…”

Acute Pancreatitis after Kidney Transplantation

“…Nevertheless, one cannot neglect the usual cause such as bile duct stones, alcohol, and hyperlipidaemia. Among the other possibilities, there is also a hyperparathyroidism, especially in patients with long-term dialysis prior to renal replacement treatment [8, 9]. There is also an important possibility of viral infection in these patients with cytomegalovirus as frequent suspect [10].…”

Operative therapie des sekundaren hyperparathyreoidismus nach nierentransplantation

“…So waren nur 2 der 9 Patienten vor der NTP hyperkalzfimisch, und bei 2 weiteren war die Serumkalziumkonzenration nur grenzwertig erh6ht. Ein Marker ffir den Schweregrad des sekund/iren HPT ist die Enwicklung der alkalischen Phosphatase nach NTP [15], die sich bei Patienten mit einer leichten Hyperkalzfimie meist zurfickbildet, bei 8 unserer 9 frfihzeitig operierten Patienten jedoch kontinuierlich weiter anstieg. Bei 2 Patienten stieg der Kalziumwert sogar um 1,2 bzw.…”

“…Innerhalb der ersten 4 Monate stieg bei allen 9 Patienten der Serumkalziumwert in einen pathologischen Bereich an und lag im Durchschnitt um 0,7 mmol/1 h6her als vor der NTP. DaB bei einer leichten Hyperkalz/imie die Entwicklung des sekundfiren Hyperparathyreoidismus l/ingerfristig beobachtet werden kann, ohne die Transplantatfunktion zu geffihrden, zeigten Arbeiten von Sitges-Serra et al [15] und unsere eigenen Daten. 1,3 mmol/1 nach der erfolgreichen NTP an.…”

“…Bei 2 Patienten stieg der Kalziumwert sogar um 1,2 bzw. Doch ist bei einem raschen Anstieg des Serumkal-124 ziumwerts auf > 3 mmol/1 das Transplantat gef/ihrdet [11,15,17]. Diese Patienten wiesen die lfingste Anamnese einer Niereninsuffizienz (27 bzw.…”