The parathyroid-bone axis in uremia: new insights into old questions

Hory, B; Tb, Drüeke

doi:10.1097/00041552-199701000-00008

Cited by 26 publications

(16 citation statements)

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“…Furthermore, the clonal characteristics of excised parathyroid tissue could also be responsible for the contradictory findings [2]. Therefore, it is probable that we classified glands composed of a single nodule, the most advanced type of NH, as glands with DH, because they appear similar [3].…”

Section: Mibi Cell Proliferation and Histology In Hyperparathyroidismentioning

confidence: 99%

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MIBI scintigraphy, indicators of cell proliferation and histology of parathyroid glands in uraemic patients

Custódio¹,

Montenegro²,

Costa³

et al. 2005

Nephrology Dialysis Transplantation

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Background. Although scintigraphy with 99m Tcsestamibi (MIBI) has been used to localize parathyroid glands prior to surgery for hyperparathyroidism, using it to evaluate parathyroid function remains controversial. The purpose of this study was to evaluate the possible association of MIBI uptake with gland weight, histological pattern and proliferative activity of parathyroid cells. Methods. We studied 18 patients with secondary hyperparathyroidism (SHP); mean age 38±3 years, 55% female, mean time on haemodialysis 7.7±0.9 years. All patients had parathyroidectomy (PTx). The weights of the removed glands were estimated, and parathyroid hyperplasia was classified as diffuse (n ¼ 28) or nodular (n ¼ 29). The expression of proliferative cell nuclear antigen (PCNA) was evaluated by immunohistochemistry. Before PTx, all patients underwent MIBI evaluation and were categorized using a 0-3 uptake scoring system. Low uptake (scores of 0 and 1) was seen in 39 glands and high uptake (scores of 2 and 3) in 18. Results. Estimated gland weights, percentage of nodular hyperplasia and PCNA expression were greater in glands with high MIBI scores than in those with low scores (P<0.01). In glands with nodular hyperplasia, PCNA expression was higher (318±66 cells/mm 2 ) than in those with diffuse hyperplasia (104±16 cells/mm 2 ; P<0.001). Conclusions. High MIBI scores were associated with high estimated gland weight, degree of cell proliferation and presence of nodular hyperplasia. MIBI scintigraphy is useful in clinical practice for localizing parathyroid glands, and it could guide the management of SHP by indicating the degree of its severity.

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Section: Mibi Cell Proliferation and Histology In Hyperparathyroidismentioning

confidence: 99%

“…A number of factors may contribute to SHP, such as hypocalcaemia, phosphate retention, vitamin D deficiency, and the reduction of vitamin D and calciumsensing receptors [2]. These factors enable not yet fully understood mechanisms that lead initially to diffuse and polyclonal cell proliferation.…”

Section: Introductionmentioning

confidence: 99%

MIBI scintigraphy, indicators of cell proliferation and histology of parathyroid glands in uraemic patients

Custódio¹,

Montenegro²,

Costa³

et al. 2005

Nephrology Dialysis Transplantation

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“…Of these 19 patients, 8 (group A) had serum iPTH levels ! 100 pg/ml persistently for at least the preceding 6 months (July to December 2001) without administration of 1,25-(OH) 2 -vitamin D 3 . The other 11 patients (group B) had iPTH levels 1 100 pg/ml persistently for the preceding 6 months.…”

Section: Methodsmentioning

confidence: 99%

Influence of Relative Hypoparathyroidism on the Responsiveness to Recombinant Human Erythropoietin in Hemodialysis Patients

Hsu

Peng²,

Pai³

et al. 2003

Blood Purif

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Background/Aim: It has been shown in a few studies examining small patient groups that high levels of intact parathyroid hormone (iPTH) were associated with a less efficient response to recombinant human erythropoietin (rHuEPO). However, the responsiveness to rHuEPO in hemodialysis (HD) patients with relative hypoparathyroidism remains undetermined. This study examines the responsiveness to rHuEPO in HD patients with relative hypoparathyroidism. Methods: We retrospectively studied 19 nondiabetic patients (mean age 44.3 ± 8.2 years, age range 29.4–55.6 years) treated with HD for chronic glomerulonephritis. Of the 19 patients, 8 (group A) had iPTH levels <100 pg/ml for the preceding 6 months without administration of 1,25-(OH)₂-vitamin D₃. Eleven patients had iPTH levels >100 pg/ml (group B). Hematocrit (Hct) and rHuEPO doses were recorded for statistical analysis. Results: In patients of groups A and B, the rHuEPO dose (U/kg/week) was 55.21 ± 16.23 vs. 84.08 ± 24.56 (p = 0.01); Hct (%) 33.29 ± 1.72 vs. 31.43 ± 2.98 (p = 0.67), and rHuEPO resistance index (weekly rHuEPO dose/Hct) 81.38 ± 16.64 vs. 155.63 ± 42.22 (p < 0.001). Furthermore, weekly rHuEPO dose and rHuEPO resistance index correlated positively with serum iPTH levels (R = 0.765, p < 0.001; R = 0.764, p < 0.001), whereas the Hct correlated negatively with serum iPTH levels (R = –0.400, p = 0.045). The alkaline phosphatase level (IU/l) was lower (50.46 ± 12.87 vs. 69.61 ± 20.68, p = 0.17) in group A. Conclusion: Our observations suggest that the lower the iPTH levels of chronic HD patients, even with relative hypoparathyroidism, the better the responsiveness to rHuEPO.

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“…Similarly, patients with chronic metabolic acidosis frequently develop bone fractures, which may occur without concomitant renal insufficiency (19). Finally, the homeostatic relationships between blood ionized calcium, parathyroid hormone (PTH), and 1,25(OH) 2 D 3 may be affected by chronic metabolic acidosis, exaggerating bone dissolution (20,21). Published experiences on the interrelationship between acidosis and bone disorders in patients after kidney transplantation are lacking.…”

Section: Introductionmentioning

confidence: 99%

Correction of Metabolic Acidosis with Potassium Citrate in Renal Transplant Patients and its Effect on Bone Quality

Starke

Corsenca

Köhler

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground Acidosis and transplantation are associated with increased risk of bone disturbances. This study aimed to assess bone morphology and metabolism in acidotic patients with a renal graft, and to ameliorate bone characteristics by restoration of acid/base homeostasis with potassium citrate.Methods This was a 12-month controlled, randomized, interventional trial that included 30 renal transplant patients with metabolic acidosis (S- [HCO 3 2 ] ,24 mmol/L) undergoing treatment with either potassium citrate to maintain S- [HCO 3 2 ] .24 mmol/L, or potassium chloride (control group). Iliac crest bone biopsies and dual-energy X-ray absorptiometry were performed at baseline and after 12 months of treatment. Bone biopsies were analyzed by in vitro micro-computed tomography and histomorphometry, including tetracycline double labeling. Serum biomarkers of bone turnover were measured at baseline and study end. Twenty-three healthy participants with normal kidney function comprised the reference group. Results Administration of potassium citrate resulted in persisting normalization of S-[HCO 32 ] versus potassium chloride. At 12 months, bone surface, connectivity density, cortical thickness, and cortical porosity were better preserved with potassium citrate than with potassium chloride, respectively. Serological biomarkers and bone tetracycline labeling indicate higher bone turnover with potassium citrate versus potassium chloride. In contrast, no relevant changes in bone mineral density were detected by dual-energy X-ray absorptiometry.Conclusions Treatment with potassium citrate in renal transplant patients is efficient and well tolerated for correction of metabolic acidosis and may be associated with improvement in bone quality. This study is limited by the heterogeneity of the investigated population with regard to age, sex, and transplant vintage.

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The parathyroid-bone axis in uremia: new insights into old questions

Cited by 26 publications

References 0 publications

MIBI scintigraphy, indicators of cell proliferation and histology of parathyroid glands in uraemic patients

MIBI scintigraphy, indicators of cell proliferation and histology of parathyroid glands in uraemic patients

Influence of Relative Hypoparathyroidism on the Responsiveness to Recombinant Human Erythropoietin in Hemodialysis Patients

Correction of Metabolic Acidosis with Potassium Citrate in Renal Transplant Patients and its Effect on Bone Quality

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