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Secondary hyperparathyroidism

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https://www.readbyqxmd.com/read/28429550/parathyroid-hormone-targets-in-chronic-kidney-disease-and-managing-severe-hyperparathyroidism
#1
Carmel M Hawley, Stephen G Holt
Appropriate targets for parathyroid hormone (PTH) in patients with chronic kidney disease (CKD) stages 3-5D are controversial, as are the means by which these targets might be achieved. Secondary hyperparathyroidism is linked to symptoms like bone pain and itch, in addition to less clinically overt issues like bone fragility as well as vascular and soft tissue calcification which may lead to adverse hard endpoints, particularly fracture and death. Recognized therapies for managing a rising PTH include vitamin D analogues, with or without calcimimetic (where available), in addition to management of serum mineral concentrations with diet, binders and dialysis...
March 2017: Nephrology
https://www.readbyqxmd.com/read/28429545/do-the-benefits-of-using-calcitriol-and-other-vitamin-d-receptor-activators-in-patients-with-chronic-kidney-disease-outweigh-the-harms
#2
Nigel D Toussaint, Matthew J Damasiewicz
The primary indication for administration of calcitriol or other vitamin D receptor activators (VDRA) in chronic kidney disease (CKD) is secondary hyperparathyroidism (SHPT). Prevention and treatment of SHPT appears important, as imbalances in mineral metabolism are associated with renal osteodystrophy, and higher parathyroid hormone (PTH) levels are associated with increased rates of mortality and morbidity in CKD patients. There is, however, a lack of controlled trial data that show lowering PTH with calcitriol/VDRA equates to improved clinical outcomes...
March 2017: Nephrology
https://www.readbyqxmd.com/read/28427988/obesity-bariatric-surgery-and-vitamin-d
#3
REVIEW
Joao Lindolfo C Borges, Isabella Santiago de M Miranda, Marta M S Sarquis, Victoria Borba, Sergio Setsuo Maeda, Marise Lazaretti-Castro, Neil Blinkey
The high prevalence of obesity is a worldwide problem associated with multiple comorbidities, including cardiovascular diseases. Vitamin D deficiency with secondary hyperparathyroidism is common in obese individuals and can be aggravated after bariatric surgery. Moreover, there is no consensus on the optimal supplementation dose of vitamin D in postbariatric surgical patients. We present new data on the variability of 25(OH)D response to supplementation in postmenopausal obese women. It is important to recognize and treat vitamin D deficiency before bariatric surgery to avoid postoperative complications, such as metabolic bone disease with associated high fracture risk...
April 17, 2017: Journal of Clinical Densitometry
https://www.readbyqxmd.com/read/28421193/molecular-abnormalities-underlying-bone-fragility-in-chronic-kidney-disease
#4
REVIEW
Yoshiko Iwasaki, Junichiro James Kazama, Masafumi Fukagawa
Prevention of bone fractures is one goal of therapy for patients with chronic kidney disease-mineral and bone disorder (CKD-MBD), as indicated by the Kidney Disease: Improving Global Outcomes guidelines. CKD patients, including those on hemodialysis, are at higher risk for fractures and fracture-related death compared to people with normal kidney function. However, few clinicians focus on this issue as it is very difficult to estimate bone fragility. Additionally, uremia-related bone fragility has a more complicated pathological process compared to osteoporosis...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28419560/fibroblast-growth-factor-23-concentration-in-dogs-with-chronic-kidney-disease
#5
L M Harjes, V J Parker, K Dembek, G S Young, L H Giovaninni, M M Kogika, D J Chew, R E Toribio
BACKGROUND: Chronic kidney disease (CKD) is associated with hyperphosphatemia, decreased vitamin D metabolite concentrations, and hyperparathyroidism. This syndrome is known as CKD-mineral bone disorder (CKD-MBD). Recently, it has been shown that an increase in fibroblast growth factor-23 (FGF-23) concentration is an early biomarker of CKD in people. It is an independent risk factor for both progression of renal disease and survival time in humans and cats with CKD. Information about FGF-23 in healthy dogs and those with CKD is lacking...
April 17, 2017: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/28405928/adynamic-bone-disease-is-a-predominant-bone-pattern-in-early-stages-of-chronic-kidney-disease
#6
REVIEW
Ziad Massy, Tilman Drueke
Chronic kidney disease (CKD) is complicated by disturbances of mineral and bone metabolism which start early in the course of the disease. It has long been assumed that high turnover bone lesions induced by secondary hyperparathyroidism are the predominant type of renal osteodystrophy from the start. However, there is increasing evidence in favor of the view that in early CKD stages low bone turnover is prevailing, with adynamic bone disease being the predominant form. Since serum parathyroid hormone levels increase progressively early on, and the most probable explanation is resistance to the skeletal action of this hormone...
April 12, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/28402557/effect-of-parathyroidectomy-and-cinacalcet-on-quality-of-life-in-patients-with-end-stage-renal-disease-related-hyperparathyroidism-a-systematic-review
#7
Willemijn Y van der Plas, Roderick R Dulfer, Anton F Engelsman, Liffert Vogt, Martin H de Borst, Tessa M van Ginhoven, Schelto Kruijff
Background.: Patients with end-stage renal disease (ESRD) have a decreased quality of life (QoL), which is attributable in part to ESRD-related hyperparathyroidism (HPT). Both cinacalcet and parathyroidectomy (PTx) are treatments for advanced HPT, but their effects on QoL are unclear. We performed a systematic review to evaluate the impact of cinacalcet and PTx on QoL. Methods.: A systematic literature search was performed using PubMed and EMBASE databases to identify relevant articles...
April 10, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28386475/retrospective-study-looking-at-cinacalcet-in-the-management-of-hyperparathyroidism-after-kidney-transplantation
#8
Habib Mawad, Hugues Bouchard, Duy Tran, Denis Ouimet, Jean-Philippe Lafrance, Robert Zoël Bell, Sarah Bezzaoucha, Anne Boucher, Suzon Collette, Vincent Pichette, Lynne Senécal, Michel Vallée
Objectives. The primary objective of this study is to evaluate the use of cinacalcet in the management of hyperparathyroidism in kidney transplant recipients. The secondary objective is to identify baseline factors that predict cinacalcet use after transplantation. Methods. In this single-center retrospective study, we conducted a chart review of all patients having been transplanted from 2003 to 2012 and having received cinacalcet up to kidney transplantation and/or thereafter. Results. Twenty-seven patients were included with a mean follow-up of 2...
2017: Journal of Transplantation
https://www.readbyqxmd.com/read/28384171/the-shift-from-high-to-low-turnover-bone-disease-after-parathyroidectomy-is-associated-with-the-progression-of-vascular-calcification-in-hemodialysis-patients-a-12-month-follow-up-study
#9
Fabiana Rodrigues Hernandes, Maria Eugênia Fernandes Canziani, Fellype Carvalho Barreto, Rodrigo Oliveira Santos, Valéria de Melo Moreira, Carlos Eduardo Rochitte, Aluizio Barbosa Carvalho
Parathyroidectomy (PTX) may cause low levels of PTH, leading to an excessive reduction of bone turnover, which is associated with poor outcomes in dialysis patients, including vascular calcification (VC). We aimed to prospectively investigate the impact of PTX on bone remodeling and its potential consequence on the progression of VC in hemodialysis patients. In this prospective study, 19 hemodialysis patients with severe secondary hyperparathyroidism (sHPT) were evaluated. All patients underwent laboratorial tests and coronary tomography at baseline and, 6 and 12 months after PTX; bone biopsy was performed at baseline and 12-month...
2017: PloS One
https://www.readbyqxmd.com/read/28383630/the-medical-and-surgical-treatment-in-secondary-and-tertiary-hyperparathyroidism-review
#10
G Cocchiara, S Fazzotta, V D Palumbo, G Damiano, M Cajozzo, C Maione, S Buscemi, G Spinelli, S Ficarella, A Maffongelli, F Caternicchia, A Ignazio Lo Monte, G Buscemi
INTRODUCTION: Hyperparathyroidism is an alteration of the pathophysiological parathyroid hormone (PTH) secretion due or an independent and abnormal release (primary or tertiary hyperparathyroidism) by the parathyroid or an alteration of calcium homeostasis that stimulates the excessive production of parathyroid hormone (secondary hyperparathyroidism). AIMS: There is not a standard, clinical or surgical, treatment for hyperparathyroidism. We review current diagnostic and therapeutic methods...
March 2017: La Clinica Terapeutica
https://www.readbyqxmd.com/read/28382631/imaging-in-chronic-kidney-disease-metabolic-bone-disease
#11
Anup J Alexander, David Jahangir, Martin Lazarus, Stuart M Sprague
Musculoskeletal manifestations in chronic kidney disease (CKD) are the result of a series of complex alterations in mineral metabolism, which has been defined as chronic kidney disease - mineral and bone-related disorder (CKD-MBD). Biochemical assessment and, at times, bone biopsy remains the mainstay of disease assessment, however, radiological imaging is an important adjunct in evaluating disease severity. This review aims to illustrate the radiological features of CKD-MBD, such as secondary hyperparathyroidism, osteomalacia, adynamic bone disease, osteopenia, and extra-skeletal calcifications...
April 5, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/28381914/pharmaceutical-approval-update
#12
Mary Choy
Abuse-deterrent hydrocodone bitartrate (Vantrela ER) for long-term opioid treatment; etelcalcetide (Parsabiv) for secondary hyperparathyroidism in patients with chronic kidney disease on hemodialysis; and deflazacort (Emflaza) for Duchenne muscular dystrophy.
April 2017: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/28379394/serum-25-hydroxyvitamin-d-insufficiency-in-search-of-a-bone-disease
#13
Sonali Shah, Cherie Chiang, Ken Sikaris, Zhong Lu, Minh Bui, Roger Zebaze, Ego Seeman
Introduction: Vitamin D 'insufficiency' and 'deficiency' are defined as a serum 25-hydroxyvitamin D (25(OH)D) below 75 and 30 nmol/L respectively. We aimed to determine whether these values signal hypocalcaemia and hypophosphatemia, secondary hyperparathyroidism, high bone remodeling, low areal bone mineral density (aBMD), microstructural deterioration, or reduced matric mineralization density (MMD), and so suggest whether bone fragility is present. Method: Concentrations of 25(OH)D, calcium, phosphate, creatinine and parathyroid hormone (PTH) were measured in 11,855 subjects...
March 30, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28378123/secondary-hyperparthyroidism-pathogenesis-diagnosis-preventive-and-therapeutic-strategies
#14
REVIEW
Mariano Rodríguez Portillo, María E Rodríguez-Ortiz
Uremic secondary hyperparathyroidism is a multifactorial and complex disease often present in advanced stages of chronic kidney disease. The accumulation of phosphate, the increased FGF23 levels, the reduction in active vitamin D production, and the tendency to hypocalcemia are persistent stimuli for the development and progression of parathyroid hyperplasia with increased secretion of PTH. Parathyroid proliferation may become nodular mainly in cases of advanced hyperparathyroidism. The alterations in the regulation of mineral metabolism, the development of bone disease and extraosseous calcifications are essential components of chronic kidney disease-mineral and bone disorder and have been associated with negative outcomes...
March 2017: Reviews in Endocrine & Metabolic Disorders
https://www.readbyqxmd.com/read/28375871/resurgence-of-parathyroidectomy-evidence-and-outcomes
#15
Hirotaka Komaba, Michio Nakamura, Masafumi Fukagawa
PURPOSE OF REVIEW: Parathyroidectomy (PTx) is the definitive therapy for refractory secondary hyperparathyroidism (SHPT). The drastic effects of PTx on biochemical parameters of SHPT increases the possibility that this intervention will lead to a reduction in the adverse outcomes related to uncontrolled SHPT. RECENT FINDINGS: The effect of PTx on mortality and cardiovascular outcomes among dialysis patients with severe SHPT have been evaluated in many observational studies from different regions of the world, including Asia, Europe, North America, and South America...
April 1, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28375869/hungry-bone-syndrome
#16
Nishank Jain, Robert F Reilly
PURPOSE OF REVIEW: In the United States, the number of parathyroidectomies among patients with chronic dialysis has remained stable in the last decade. A fall in serum calcium concentration is common postparathyroidectomy in patients with hyperparathyroidism, which usually resolves in 2-4 days. A severe drop in serum total calcium concentration less than 2.1 mmol/L and/or prolonged hypocalcemia for more than 4 days postparathyroidectomy is called hungry bone syndrome (HBS). Concomitant hypophosphatemia, hypomagnesemia, and hyperkalemia can be seen...
April 1, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28374221/less-is-more-time-to-expand-the-indications-for-minimally-invasive-video-assisted-parathyroidectomy
#17
S Bakkar, V Matteucci, C Corsini, S Pagliaro, P Miccoli
PURPOSE: Minimally invasive video-assisted parathyroidectomy (MIVAP) is one of the most widespread targeted parathyroid surgeries for primary hyperparathyroidism (PHP). The aim of this study was to assess its limits and propose an expansion of its indications in the management of parathyroid pathology. METHODS: A retrospective analysis of 77 consecutive patients who underwent MIVAP for PHP between Jan and Oct 2016 was conducted. The adequacy of the procedure and/or the need to convert to a standard cervicotomy was the main outcome of interest...
April 3, 2017: Journal of Endocrinological Investigation
https://www.readbyqxmd.com/read/28367941/changes-in-bone-metabolic-parameters-following-oral-calcium-supplementation-in-an-adult-patient-with-vitamin-d-dependent-rickets-type-2a
#18
Yuka Kinoshita, Nobuaki Ito, Noriko Makita, Masaomi Nangaku, Seiji Fukumoto
Vitamin D-dependent rickets type 2A (VDDR2A) is a rare inherited disorder with decreased tissue responsiveness to 1,25-dihydroxyvitamin D [1,25(OH)2D], caused by loss of function mutations in the vitamin D receptor (VDR) gene. Approximately 50 types of mutations have been identified so far that change amino acids in either the N-terminal DNA binding domain (DBD) or the C-terminal ligand binding domain (LBD) of the VDR protein. The degree of responsiveness to 1,25(OH)2D varies between patients with VDDR2A, which may depend on their residual VDR function...
March 31, 2017: Endocrine Journal
https://www.readbyqxmd.com/read/28355398/cinacalcet-in-peritoneal-dialysis-patients-one-center-experience
#19
Sara Querido Conde, Patrícia Branco, Henrique Sousa, Teresa Adragão, Augusta Gaspar, José Diogo Barata
INTRODUCTION: Secondary hyperparathyroidism is the target of several therapeutic strategies, including the use of cinacalcet. Most studies were done only in hemodialysis patients, with few data from peritoneal dialysis patients. OBJECTIVE: The aim of our work was to evaluate the effectiveness of cinacalcet in secondary hyperparathyroidism in a one-center peritoneal dialysis patients. METHODS: A retrospective study was performed in 27 peritoneal dialysis patients with moderate to severe secondary hyperparathyroidism (PTHi > 500 pg/mL with normal or elevated serum calcium levels) treated with cinacalcet...
March 2017: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
https://www.readbyqxmd.com/read/28348181/trajectories-of-ckd-mbd-biochemical-parameters-over-a-2-year-period-following-diagnosis-of-secondary-hyperparathyroidism-a-pharmacoepidemiological-study
#20
Pierre Filipozzi, Carole Ayav, Willy Ngueyon Sime, Emmanuelle Laurain, Michèle Kessler, Laurent Brunaud, Luc Frimat
OBJECTIVES: To define groups of patients according to the changes of biochemical parameters, that is, serum calcium, phosphate and parathyroid hormone (PTH), over a 2-year follow-up period using group-based multi-trajectory modeling (GBMM) among a cohort of dialysis patients with newly diagnosed secondary hyperparathyroidism (SHPT) (ie, PTH≥500 ng/L for the first time) and to compare their patient characteristics and treatments. DESIGN: Pharmacoepidemiological study...
March 27, 2017: BMJ Open
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