Hyperparathyroidism is a common complication of end-stage renal insufficiency, with a high morbi-mortality and difficult medical control. Classical indications for parathyroidectomy are: persistent hypercalcemia, especially after kidney transplantation, untreatable pruritus, pathologic fractures, bone pain refractory to medical treatment, and metastatic calcifications. Unfortunately, this latter complication does not respond to parathyroidectomy, and blood vessels calcifications are associated with increased mortality. Severe osteitis fibrosa and bone deformities also never disappear. Thus, new criteria for early parathyroidectomy are needed. Serum intact PTH higher than 10 times the upper limit of normality despite adequate calcium and calcitriol supplements, calcium-phosphorus product higher than 70(mg/dL)², ''brown tumor'' whenever a rapid regression is needed, incapacitating arthritis and/or periarthritis, and rupture of tendons are among other indications that should be considered. Care must be taken to exclude concomitant diseases such as amiloidosis and aluminum intoxication. This review intends to advise endocrinologists about the indications and timing of surgery in hyperparathyroidism due to chronic renal failure.
Secondary hyperparathyroidism; Renal osteodystrophy; Parathyroidectomy; Parathyroid hormone
