Hyperparathyroidism of Renal Disease

Abstract

Renal hyperparathyroidism (rHPT) is a common complication of chronic kidney disease characterized by elevated parathyroid hormone levels secondary to derangements in the homeostasis of calcium, phosphate, and vitamin D. Patients with rHPT experience increased rates of cardiovascular problems and bone disease. The Kidney Disease: Improving Global Outcomes guidelines recommend that screening and management of rHPT be initiated for all patients with chronic kidney disease stage 3 (estimated glomerular filtration rate, < 60 mL/min/1.73 m(2)). Since the 1990s, improving medical management with vitamin D analogs, phosphate binders, and calcimimetic drugs has expanded the treatment options for patients with rHPT, but some patients still require a parathyroidectomy to mitigate the sequelae of this challenging disease.

Figure 1.

Schematic of the pathogenesis of renal hyperparathyroidism. CKD = chronic kidney disease; FGF-23 = fibroblast growth factor 23.

Figure 2.

Radiograph of the hands of a 55-year-old patient with renal osteodystrophy and brown tumors of the fourth metacarpal and third phalanx of the left hand (arrows). Image is courtesy of John Hunter, MD.

Figure 3.

Radiograph of the right hip of a 63-year-old man with tumoral calcinosis.