Kronik Böbrek Hastalikli Hastalarda Sekonder Hiperparatiroidizm: Tani, Medikal ve Cerrahi Tedavi/Secondary hyperparathyroidism in patients with chronic kidney disease: Diagnosis, pharmacological and surgical treatment

Secondary hyperparathyroidism (SHPT) is a secondary adaptive response to maintain calcium homeostasis and caused by any condition associated with chronically reduced serum calcium (Ca) levels, and low serum Ca levels lead to compensatory overactivity of the parathyroid gland. It is a common complication of chronic kidney disease (CKD) and is part of the CKD-mineral bone disorder (CKD-MBD). SHPT is associated with increased risk of morbidity and mortality; thus, SHPT control is recommended. The diagnosis of patients with SHPT requires a combination of clinical investigation and laboratory findings. In addition, patients with SHPT have extremely elevated parathyroid levels, elevated or normal alkaline phosphatase levels and decreased vitamin D levels. Untreated SHPT leads to progressive bone disease, osteitis fibrosa cystica, and soft tissue calcifications. Patients may experience intractable bone pain, fractures, pruritis, soft tissue or vascular calcifications, calciphylaxis, erythropoietin resistant anemia, and mental status changes. Hypocalcemia is the most common postoperative complication requiring aggressive calcium administration. Benefits of surgical treatment may include improved survival, bone mineral density and alleviation of symptoms.