TY - JOUR
T1 - Persistent secondary hyperparathyroidism after renal transplantation
AU - Messa, Piergiorgio
AU - Sindici, Chiara
AU - Cannella, Giuseppe
AU - Miotti, Valeria
AU - Risaliti, Andrea
AU - Gropuzzo, Maria
AU - Di Loreto, Pier Luigi
AU - Bresadola, Fabrizio
AU - Mioni, Giuseppe
PY - 1998
Y1 - 1998
N2 - Background. The persistence of secondary hyperparathyroidism after renal transplantation is frequent and often complicated by overt hypercalcemia. Recent investigations have shown an effect of the different vitamin D receptor (VDR) genotypes on parathyroid hormone (PTH) secretion in both primary and secondary hyperparathyroidism. The aims of this study were (i) to assess whether persistent secondary hyperparathyroidism after renal transplantation is characterized by any change in calcium-controlled PTH secretion, and (ii) whether different VDR allelic distributions might play any role on this setting. Methods. Eighty-one cadaveric renal transplantation recipients, followed-up for at least 12 months, were checked for PTH, other primary metabolic and clinical variables, and VDR B/b alleles (BsmI). In 22 of these the following parameters were evaluated: (a) kinetics parameters of the Ca-PTH relation curve; (b) vertebral mineral density; (c) calcitriol serum levels; (d) PTH-related peptide serum levels; and (e) urinary hydroxyproline. Results. According to the stabilised PTH levels (reached by the third month), the patients were divided in two groups: group A (N = 40, PTH <80 pg/ml) and group B (N = 41, PTH > 80 pg/ml). Group B differed from group A in that patients had higher PTH levels at the time of transplantation, were older in age, and spent more time on dialysis. Group B had increased maximal and minimal PTH levels, and higher set-point levels than Group A. The patients with the BB pattern of VDR genotype were characterized by the lowest PTH levels both at time of transplantation and after stabilization, and lower set point values than patients with Bb and bb patterns. Conclusions. Our study suggests that (i) the severity of preexisting secondary hyperparathyroidism is the main factor determining its persistence after renal transplantation, (ii) persistent secondary hyperparathyroidism is characterized by an autonomous pattern of PTH secretion, (iii) the VDR BB genotype seems to be related to lower PTH levels.
AB - Background. The persistence of secondary hyperparathyroidism after renal transplantation is frequent and often complicated by overt hypercalcemia. Recent investigations have shown an effect of the different vitamin D receptor (VDR) genotypes on parathyroid hormone (PTH) secretion in both primary and secondary hyperparathyroidism. The aims of this study were (i) to assess whether persistent secondary hyperparathyroidism after renal transplantation is characterized by any change in calcium-controlled PTH secretion, and (ii) whether different VDR allelic distributions might play any role on this setting. Methods. Eighty-one cadaveric renal transplantation recipients, followed-up for at least 12 months, were checked for PTH, other primary metabolic and clinical variables, and VDR B/b alleles (BsmI). In 22 of these the following parameters were evaluated: (a) kinetics parameters of the Ca-PTH relation curve; (b) vertebral mineral density; (c) calcitriol serum levels; (d) PTH-related peptide serum levels; and (e) urinary hydroxyproline. Results. According to the stabilised PTH levels (reached by the third month), the patients were divided in two groups: group A (N = 40, PTH <80 pg/ml) and group B (N = 41, PTH > 80 pg/ml). Group B differed from group A in that patients had higher PTH levels at the time of transplantation, were older in age, and spent more time on dialysis. Group B had increased maximal and minimal PTH levels, and higher set-point levels than Group A. The patients with the BB pattern of VDR genotype were characterized by the lowest PTH levels both at time of transplantation and after stabilization, and lower set point values than patients with Bb and bb patterns. Conclusions. Our study suggests that (i) the severity of preexisting secondary hyperparathyroidism is the main factor determining its persistence after renal transplantation, (ii) persistent secondary hyperparathyroidism is characterized by an autonomous pattern of PTH secretion, (iii) the VDR BB genotype seems to be related to lower PTH levels.
KW - Bone mineral density
KW - Calcium
KW - Hypercalcemia
KW - Parathyroid hormone kinetics
KW - VDR genotype
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U2 - 10.1046/j.1523-1755.1998.00142.x
DO - 10.1046/j.1523-1755.1998.00142.x
M3 - Article
C2 - 9844148
AN - SCOPUS:0031759893
VL - 54
SP - 1704
EP - 1713
JO - Kidney International
JF - Kidney International
SN - 0085-2538
IS - 5
ER -