Severe hyperparathyroidism in a pre-dialysis chronic kidney disease patient treated with a very low protein diet
Severe hyperparathyroidism in a pre-dialysis chronic kidney disease patient treated with a very low protein diet
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接受极低蛋白质饮食治疗的透析前慢性肾病患者出现严重甲状旁腺功能亢进
DOI：
10.1007/s00774-011-0320-6
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Ohta E
中科院分区：
文献类型：
--
作者：
Asano;H.;Horinouchi;T.;Mai;Y.;Sawada;O.;Fujii;S.;Nishiya;T.,;星暁壮，堀之内孝広，原田拓弥，比嘉綱己，東恒仁，寺田晃士，眞井洋輔，ネパル・プラハ，堀口美香，旗手千鶴，三輪聡一;Ohta E
本报告描述了一例64岁的透析前女性慢性肾脏病（CKD）5期，谁开发严重甲状旁腺功能亢进症。该患者一直接受极低蛋白饮食（VLPD），以延迟CKD进展和肾脏替代治疗（RRT）的需要。在此期间，她的血清钙水平高-正常至略高。然而，她的血清全段甲状旁腺激素（PTH）水平从400上升到1160 pg/ml迅速超过3个月。血清1，25-（OH）2D水平较低，颈部超声显示三个明显增大的甲状旁腺超过2 cm。行甲状旁腺切除术，所有腺体均显示结节性增生，表明重度继发性甲状旁腺功能亢进导致第三次甲状旁腺功能亢进。需要手术干预的重度继发性甲状旁腺功能亢进通常在长期RRT患者中观察到，在透析前患者中相对罕见。在这种情况下，VLPD延长透析前期可能使该患者易于发生重度继发性甲状旁腺功能亢进。因此，即使在肾脏替代治疗之前，对VLPD治疗的患者也需要仔细监测钙、磷和PTH。此外，严格的蛋白质限制饮食疗法不应过度延迟透析的开始。
The present report describes a case of a 64-year-old pre-dialysis woman with chronic kidney disease (CKD) stage 5, who developed severe hyperparathyroidism. This patient had been on a very low protein diet (VLPD) to delay the progression of CKD and the need for renal replacement therapy (RRT). Her serum calcium levels were high-normal to slightly high during this time. However, her serum intact parathyroid hormone (PTH) levels increased from 400 to 1160 pg/ml rapidly over a period of 3 months. Serum 1,25-(OH)2D levels were low, and ultrasound of the neck showed three markedly enlarged parathyroid glands exceeding 2 cm. Parathyroidectomy was performed, and all glands showed nodular hyperplasia, which indicated severe secondary hyperparathyroidism leading to tertiary. Severe secondary hyperparathyroidism requiring surgical intervention is usually observed in patients with long-term RRT and is relatively rare in the pre-dialysis patient. In this case, extension of the pre-dialysis period by VLPD may have predisposed this patient to develop severe secondary hyperparathyroidism. Thus, careful monitoring of calcium, phosphorus, and PTH may be necessary in patients treated with VLPD even before renal replacement therapy. Furthermore, initiation of dialysis should not be excessively delayed by strict protein restriction dietary therapy.