Physiologic studies in renal osteodystrophy treated by subtotal parathyroidectomy

Two patients with advanced renal insufficiency and osteitis fibrosa cystica were found to have severe renal salt-wasting and hypercalciuria. Medullary cysts were demonstrated at postmortem in one case and suspected in the other. The level of parathyroid hormone in plasma was greatly elevated. Both patients were treated with subtotal parathyroidectomy for renal osteodystrophy. In each there was clinical and roentgenologic evidence of bone healing and decreased metastatic calcification. There was a slow decrease in the circulating levels of parathyroid hormone after parathyroid tissue was removed. In one patient the level returned to normal, in the other it fell to one tenth of the preoperative level. Renal tubular reabsorption of phosphate was extremely low and was unaffected by subtotal parathyroidectomy, suggesting that parathyroid hormone was not the primary factor responsible for the abnormal renal handling of phosphate in these uremic patients.