Secondary hyperparathyroidism : update on pathogenesis, diagnosis and treatment

Secondary hyperparathyroidism is a frequently encountered problem in the management of patients with chronic kidney disease (CKD). Its pathophysiology is mainly due to hyperphosphatemia, vitamin D deficiency and resistance. Resistance in the form of downregulation in parathyroid vitamin D and calcium-sensing receptors represent critical steps in pathogenesis. Eventually abnormalities in mineral phosphate, calcium, and vitamin D begin to appear. Lack of control of serum PTH and associated minerals result in bone pathologies and vascular calcification. This condition has a high impact on the mortality and morbidity of dialysis patients. Early diagnosis of secondary hyperparathyroidism is crucial in the management of patients with CKD. Achieving current targets for the key mineral parameters in the management of SHPT set by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines can be challenging. This review summarizes the current understanding and evidence supporting strategies for SHPT treatment in CKD patients. Treatment should include a combination of dietary phosphorus restriction, phosphate binders, vitamin D sterols, and calcimimetics. Parathyroidectomy is effective in suitable candidates’ refractory to medical therapy and the standard against which new approaches should be measured

Secondary hyperparathyroidism : update on pathogenesis, diagnosis and treatment

Secondary hyperparathyroidism is a frequently encountered problem in the management of patients with chronic kidney disease (CKD). Its pathophysiology is mainly due to hyperphosphatemia, vitamin D deficiency and resistance. Resistance in the form of downregulation in parathyroid vitamin D and calcium-sensing receptors represent critical steps in pathogenesis. Eventually abnormalities in mineral phosphate, calcium, and vitamin D begin to appear. Lack of control of serum PTH and associated minerals result in bone pathologies and vascular calcification. This condition has a high impact on the mortality and morbidity of dialysis patients. Early diagnosis of secondary hyperparathyroidism is crucial in the management of patients with CKD. Achieving current targets for the key mineral parameters in the management of SHPT set by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines can be challenging. This review summarizes the current understanding and evidence supporting strategies for SHPT treatment in CKD patients. Treatment should include a combination of dietary phosphorus restriction, phosphate binders, vitamin D sterols, and calcimimetics. Parathyroidectomy is effective in suitable candidates’ refractory to medical therapy and the standard against which new approaches should be measured

Secondary hyperparathyroidism : update on pathogenesis, diagnosis and treatment

Secondary hyperparathyroidism is a frequently encountered problem in the management of patients with chronic kidney disease (CKD). Its pathophysiology is mainly due to hyperphosphatemia, vitamin D deficiency and resistance. Resistance in the form of downregulation in parathyroid vitamin D and calcium-sensing receptors represent critical steps in pathogenesis. Eventually abnormalities in mineral phosphate, calcium, and vitamin D begin to appear. Lack of control of serum PTH and associated minerals result in bone pathologies and vascular calcification. This condition has a high impact on the mortality and morbidity of dialysis patients. Early diagnosis of secondary hyperparathyroidism is crucial in the management of patients with CKD. Achieving current targets for the key mineral parameters in the management of SHPT set by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines can be challenging. This review summarizes the current understanding and evidence supporting strategies for SHPT treatment in CKD patients. Treatment should include a combination of dietary phosphorus restriction, phosphate binders, vitamin D sterols, and calcimimetics. Parathyroidectomy is effective in suitable candidates’ refractory to medical therapy and the standard against which new approaches should be measured