Renal osteodystrophy (ROD) with secondary hyperparathyroidism (2°HPT) is a serious complication in patients who have received long term maintenance hemodialysis. In patients whose bone pain, bone fracture and bone deformity are resistant to medical treatment with aluminium hydrochloride, 1α-OH D
3, etc, and whose serum parathyroid hormone (c-PTH) is elevated, parathyroidectomy is generally performed.
We report herein two patients who underwent total parathyroidectomy and autoplantation of the parathyroid graft in the left forearm, and subsequently showed amelioration of clinical signs and laboratory data..
Case 1 is 29-year-old man. He was diagnosed as chronic proliferative glomerulonephritis with nephrotic syndrome in 1972 and received some medications, but his renal function gradually deteriorated. Hemodialysis was started in 1975. In May 1982, facial change and pain in the lumbar region and the chest were noted. He received 1α-OH D
3, but without any effects. Therefore he was admitted to the hospital in December 1982. On laboratory examination, serum alkali-phosphatase (Al-ptase) and c-PTH were found to be elevated to 97.5 K.A.units, and 25.5ng/ml, respectivdly. He received total parathyroidectomy and autoplantation of the parathyroid graft in the left forearm.
Three days after the operation, his bone pain disappeared, and he remained free from pain until 1985.
Case 2 is 33-year-old woman.She was diagnosed as chronic proliferative glomerulonephritis in 1971, and hemodialysis was started in 1979. In March 1982, she complainted pain in the bilateral knee joints and heels. In November 1983, laboratory examination revealed that serum Al-ptase and c-PTC were elvated to 69 K.A. units and 34.2ng/ml, respectively. She was diagnosed as ROD with 2°HPT and underwent total parathyroidectomy and heterotopic autoplantation. Two days after the operation, her complaint disappeared.
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