This article appears in the following NDT Plus issue: Parathyroid Intervention - Current themes and future perspectives [View the issue table of contents]
Medical management after parathyroid intervention
1 Department of Nephrology, Akebono Clinic, Kumamoto, Kumamoto
2 Division of Nephrology and Kidney Center, Kobe University School of Medicine, Kobe, Hyogo, Japan
Correspondence: Motoko Tanaka, Department of Nephrology, Akebono Clinic, 5-1-1, Shirafuji, Kumamoto 861-4112, Japan. Tel: +81-96-358-7211; Fax: +81-96-358-7226; E-mail: tanaka{at}matusita-kai.or.jp
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Abstract |
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Vitamin D or vitamin D analogues pulse therapy is seldom effective in patients with at least one parathyroid gland with nodular hyperplasia, and surgical parathyroidectomy or parathyroid intervention is indicated. In parathyroid interventions, especially in selective percutaneous ethanol injection therapy (PEIT), the enlarged parathyroid gland(s) with nodular hyperplasia is selectively destroyed by ethanol injection, while other glands with diffuse hyperplasia are managed by medical therapy. Thus, medical management, e.g., use of appropriate dose of vitamin D or vitamin D analogues after the PEIT procedure, is as important as the destruction of the hyperplastic tissue itself. Recent studies showed that the combination of PEIT and intravenous vitamin D pulse therapy lead to reduce serum PTH level and calcium-phosphorus products in haemodialysis patients. In this article, we focus on the importance of medical therapy after PEIT, and review the efficacy of the combination of PEIT and intravenous vitamin D pulse therapy for haemodialysis patients with secondary hyperparathyroidism.
Key Words: haemodialysis • intravenous vitamin D therapy • percutaneous ethanol injection therapy (PEIT) • secondary hyperparathyroidism
Received for publication February 28, 2008. Accepted for publication March 21, 2008.