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Review
. 2019 Jul-Aug;23(4):391-399.
doi: 10.4103/ijem.IJEM_292_19.

Secondary and Tertiary Hyperparathyroidism in Chronic Kidney Disease: An Endocrine and Renal Perspective

Manju Chandran  1 , Jiunn Wong  2
Affiliations
Review

Secondary and Tertiary Hyperparathyroidism in Chronic Kidney Disease: An Endocrine and Renal Perspective

Manju Chandran et al. Indian J Endocrinol Metab. 2019 Jul-Aug.

Abstract

Secondary Hyperparathyroidism (SHP) seen as a frequent complication in Chronic Kidney Disease (CKD) has many pathogenetic peculiarities that are still incompletely defined and understood. During the long course of chronic renal failure, SHP can also transform sometimes into the hypercalcemic state characterized by quasi-autonomous production of Parathyroid Hormone from the parathyroid glands: a disorder that is termed Tertiary Hyperparathyroidism. The clinical consequences of SHP in CKD are protean, encompassing bone and mineral abnormalities but as recently identified, also several metabolic and cardiovascular problems, the most important of which is vascular calcification. There have been several advances in the therapeutic armamentarium available for the treatment of SHP, though clear demonstration of a benefit regarding major clinical outcomes with any of the new agents is still lacking. This narrative review summarizes the current understanding about this disorder and highlights some of the recent research on the subject.

Keywords: CKD; FGF-23; parathyroid hyperplasia; renal failure; secondary hyperparathyroidism; tertiary hyperparathyroidism.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic representation of the current understanding regarding the pathophysiology of SHP
Figure 2
Figure 2
The stages in the evolution of secondary and tertiary hyperparathyroidism
Figure 3
Figure 3
Schematic representation of the three generations of PTH assays
See this image and copyright information in PMC

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