Clinical analysis of persistent hypercalcemia with osteoporosis caused by tertiary hyperparathyroidism after kidney transplantation
10.3760/cma.j.issn.0254-1785.2019.02.007
- VernacularTitle:肾移植术后三发性甲状旁腺功能亢进诱导持续高钙血症伴骨质疏松
- Author:
Suya WANG
1
;
Jianyong WU
;
Wenhan PENG
;
Rending WANG
;
Hongfeng HUANG
;
Jianghua CHEN
Author Information
1. 浙江大学医学院附属第一医院肾脏病中心 浙江省肾脏病防治技术研究重点实验室国家临床重点专科 浙江大学肾脏病研究所 国家中医药管理局三级实验室"肾脏病免疫实验室"
- Keywords:
Kidney transplantation;
Tertiary hyperparathyroidism;
Hypercalcemia;
Osteoporosis
- From:
Chinese Journal of Organ Transplantation
2019;40(2):92-97
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the clinical characteristics of tertiary hyperparathyroidism (THPT) after renal transplantation .Methods The levels of bone mineral density (BMD) , serum calcium , phosphates , alkaline phosphatase (ALP) and intact parathyroid hormone (iPTH ) were retrospectively analyzed in 36 RTx recipients with persistent hypercalcemia and stable kidney function (eGFR 76 .71 ± 17 .44) ml/min/1 .73 m2 .Results Among them ,serum total calcium level increased (2 .97 ± 0 .20 ) mmol/L for 6 to 170 months ,blood phosphorus decreased (0 .59 ± 0 .19 ) mmol/L , serum alkaline phosphatase (ALP) increased to (295 .73 ± 194 .22)U/L and T-score of BMD decreased (T - 2 .78 ± 0 .84 in lumbar vertebrae and T - 2 .09 ± 0 .66 in hip joint) .And 11 /36 (30 .6％ ) cases had a complication of extraosseous calcification .Parathyroid hyperplasia was detected in 17 /36 cases (47 .2％ ) .iPTH was significantly higher at pre-operation and 1 week post-operation than that in control group (n= 45) (859 .50 ± 495 .44 vs 345 .56 ± 216 .55 pg/ml) , P = 0 .001 ,(759 .25 ± 907 .07 vs 197 .45 ± 249 .31 pg/ml) , P= 0 .001 .The value of iPTH at the last follow-up (198 .26 ± 155 .22) pg/ml was still higher than normal reference value (15 .0 - 65 .0 pg/ml) . Multivariate stepwise regression analysis showed the last iPTH was correlated with preoperative iPTH ,serum calcium and postoperative serum phosphor ,ALP and 25OHD3 (P= 0 .024 , P= 0 .002 , P = 0 .001 , P = 0 .037 , P = 0 .026 ) .Conclusions Renal recipients had a higher levels iPTH with persistent hypercalcemia , hypophosphatemia , osteoporosis and extraosseous calcification showing the features of tertiary hyperparathyroidism .
