Dr. Akbar Mahmood
Nephrologist at sultan qaboos uviversity hospital, Oman
Title: Approach to renal hyperparathyroidism-A stitch in time saves nine
Biography:
Abstract:
Advance CKD and dialysis results into a state of affairs where PTH, an important stake holder for bone health turns into an enemy with a catastrophic outcome due to persistent skeletal dysregulation towards continuous PTH release from the parathyroid gland. Harmony between FGF 23,klotho produced from the osteocytes, Ca, Pi absorption from the gut and calcitriol from the kidney causes hyperactivity of parathyroid gland to preserve architectural strength and integrity of the bony skeletal . This protective mechanism exhausts if goes unnoticed and not intervene timely leading to an extent that parathyroid gland becomes autonomic due to the depletion and insensitivity of CaSR into the gland, failure of feedback mechanism . Continuous surges of PTH resorp skeleton risking low trauma fractures, change in the individual`s appearance with reduction in height, deformities and strength, stones and vascular calcifications threatening vital organs risking life. Commonly prescribed Cinacalcet is not a cost effective and definitive solution. In fact parathyroidectomy is the right way to deal this misdirected mineral bone renal disorder. Surgery is a permanent treatment which should be considered during the initial phase of disordered PTH, CKD MBD. Parathyroidectomy is a definitive and cost effective solution which outweighs morbidity and mortality benefits against surgical risks and importance of this surgery increases manifolds especially when kidney transplant is aim to help patient and graft survival.