Total Parathyroidectomy without Autotransplantion Effective Treatment in Renal “Refractory” Chronic Kidney Disease – Metabolic Bone Disease
(Pages 7-12)

M.R. Diaconescu1, M. Glod1, I. Costea1 and S. Diaconescu2

1IVth Surgical Clinic; 2Vth Pediatric Clinic, “Gr T Popa” University of Medicine and Pharmacy Iasi, Romania

DOI: http://dx.doi.org/10.12970/2310-984X.2015.03.01.2

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Abstract: Introduction: Aim of our study attempts to demonstrate the superiority and benefits of total parathyroidectomy without autotransplantation (TPtx) versus subtotal parathyroidectomy (STPtx) or total parathyroidectomy with autotransplantation (TPtx+At) in cases of refractory, adenomised “renal” hyperparathyroidism, actually renamed Chronic Kidney Disease – Metabolic Bone Disease (CKD – BMD).

Patients Study Design: Sixtytwo cases with CKD – MBD underwent surgery between 1994-2013. There were 25 SPtx and 9 TPtx+At both procedures determining 7 (18,4%) recurrences so in the last decade we performed preponderantly TPtx in 28 selected patients (12 males and 16 females, with median age of 43,6 (range) 22 – 66 years and median hemodialysis before surgery of 8,5 (range 3-12) years. Demography, clinical and biological data, imaging procedures, surgical protocols and pathology reports together with immediate and long-term results were recorded.

Results and Discussions: Main indications for TPtx were severe bone disease, soft tissue calcifi-cations, neuromuscular features, grossly elevated iPTH and sometimes hypercalcemia. TPtx were done in 27 subjects in the 28th one suffering a completion PTx one year after outward exeresis of only two gland. One patient required a re-exploration for a cervical hematoma but none presen-ted permanent hypocalcemia or recurrent hyperparathyroidism. Pathology revealed nodular hyperplasia in all cases but a parathyroid carcinoma of the fourth gland and an incidentally papi-llary thyroid microcarcinoma were found in each one case. Follow-up at 6-60 months showed in 24 cases (87,7%) an effective clinical and biological improvement stable over time, continuing their hemodialysis regimen.

Conclusions: TPtx alone proved to be an an equally safe and successful as another techniques currently used in management of CKD – MBD eliminating the hyperparathyroid status but being superior in regard to apparition of recurrences. The procedure is indicated especially in patients with aggressive, refractory forms of this condition without the prospect of renal transplant.
Keywords: Renal hyperparathyroidism, CKD – MBD, total parathyroidectomy, kidney transplant. Read more →