Dr. Alok Kumar Rajpoot
Professor and HOD, Department of Nephrology,
Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India
Dr. Alok Kumar Rajpoot
Professor and HOD, Department of Nephrology,
Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India
Abstract
Chronic kidney disease (CKD) and the resultant uremia cause a multitude of endocrine derangements and associated morbidity and negatively influence the quality of life in these patients. One of the important renal endocrine involvement deals with the parathyroid hormone (PTH) metabolism. Secondary and tertiary hyperparathyroidism are the main metabolic bone diseases of CKD. This systemic disorder of bone and mineral metabolism causes abnormalities in calcium, phosphorus, PTH, and vitamin D. The treatment works along the lines of management of underlying pathology covering for malnutrition, improving general health state, and optimizing renal replacement. The management of secondary hyperparathyroidism includes a combination of dietary phosphorus restriction, phosphate binders, vitamin D analogs, and calcimimetics. However, the management for tertiary hyperparathyroidism is less evidence-based and the main treatment is surgery. Determining the optimal treatment for the individual patient is challenging for nephrologists and endocrine surgeons.
Keywords: Chronic kidney disease; Secondary hyperparathyroidism; Tertiary hyperparathyroidism; Parathyroid hormone