April - June 2005, Volume 1, Issue 2
Endocrine Care
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Acta Endocrinologica (Buc)
Mircescu G, Capusa C, Andreiana I
The management of secondary hyperparathyroidism in chronic kidney disease
Acta Endo (Buc) 2005, 1 (2): 181-200doi: 10.4183/aeb.2005.181
Secondary hyperparathyroidism, i.e. increased synthesis and secretion of parathyroid hormone and gland hyperplasia, is commonly found in chronic kidney disease. Although it is, at first, an adaptive response to the loss of renal functions in order to maintain the calcium/phosphate homeostasis and normal bone turnover, it is also an important cause of increased morbidity in this clinical setting by leading to renal osteodystrophy and cardiovascular complications. Recent advances in the knowledge on the pathogenesis of parathyroid-related complications in renal failure allowed for new therapeutic approaches. However, many problems remain to be solved in the future. This paper briefly presents the current understanding of pathogenic mechanisms of hyperparathyroidism, bone disease and vascular calcification during chronic kidney disease. In addition, it summarizes the main therapeutic methods available today for controlling secondary hyperparathyroidism and the challenges of practitioners concerning this issue. Finally, the current status of secondary hyperparathyroidism management is analyzed, with emphasis on the Romanian experience.
Keywords: Secondary hyperparathyroidism, renal osteodystrophy, calcitriol, management, guidelines
Correspondence: Gabriel Mircescu, MD, ?Carol Davila? University of Medicine and Pharmacy, Department of Internal Medicine and Nephrology, ?Carol Davila? Hospital, Bucharest, Calea Grivitei, no. 4, tel/fax: +4021.3189194, email: davilla@rdsnet.ro.
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