Clinical analysis of persistent hypercalcemia with osteoporosis caused by tertiary hyperparathyroidism after kidney transplantation

Chineae Journal of Organ Transplantation Pub Date : 2019-02-20 DOI:10.3760/CMA.J.ISSN.0254-1785.2019.02.007

Su-ya Wang, Jianyong Wu, W. Peng, Rending Wang, Hongfeng Huang

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Abstract

Objective To explore the clinical characteristics of tertiary hyperparathyroidism (THPT) after renal transplantation. Methods The levels of bone mineral density (BMD), serum calcium, phosphates, alkaline phosphatase (ALP) and intact parathyroid hormone (iPTH) were retrospectively analyzed in 36 RTx recipients with persistent hypercalcemia and stable kidney function (eGFR 76.71±17.44) ml/min/1.73 m2. Results Among them, serum total calcium level increased (2.97±0.20) mmol/L for 6 to 170 months, blood phosphorus decreased (0.59±0.19) mmol/L, serum alkaline phosphatase (ALP) increased to (295.73±194.22)U/L and T-score of BMD decreased (T-2.78±0.84 in lumbar vertebrae and T-2.09±0.66 in hip joint). And 11/36 (30.6%) cases had a complication of extraosseous calcification. Parathyroid hyperplasia was detected in 17/36 cases (47.2%). iPTH was significantly higher at pre-operation and 1 week post-operation than that in control group (n=45) (859.50±495.44 vs 345.56±216.55 pg/ml), P=0.001, (759.25±907.07 vs 197.45±249.31 pg/ml), P=0.001. The value of iPTH at the last follow-up (198.26±155.22) pg/ml was still higher than normal reference value (15.0-65.0 pg/ml). Multivariate stepwise regression analysis showed the last iPTH was correlated with preoperative iPTH, serum calcium and postoperative serum phosphor, ALP and 25OHD3 (P=0.024, P=0.002, P=0.001, P=0.037, P=0.026). Conclusions Renal recipients had a higher levels iPTH with persistent hypercalcemia, hypophosphatemia, osteoporosis and extraosseous calcification showing the features of tertiary hyperparathyroidism. Key words: Kidney transplantation; Tertiary hyperparathyroidism; Hypercalcemia; Osteoporosis

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肾移植术后三期甲状旁腺功能亢进致持续性高钙血症伴骨质疏松症的临床分析

目的探讨肾移植术后三期甲状旁腺功能亢进(THPT)的临床特点。方法回顾性分析36例持续性高钙血症、肾功能稳定(eGFR 76.71±17.44)ml/min/1.73 m2的RTx患者的骨密度(BMD)、血清钙、磷酸盐、碱性磷酸酶(ALP)和完整甲状旁腺激素(iPTH)水平。结果6 ~ 170个月血清总钙升高(2.97±0.20)mmol/L，血磷降低(0.59±0.19)mmol/L，血清碱性磷酸酶(ALP)升高(295.73±194.22)U/L，骨密度t评分降低(腰椎T-2.78±0.84，髋关节T-2.09±0.66)。11/36例(30.6%)合并骨外钙化。甲状旁腺增生17/36例(47.2%)。术前和术后1周iPTH明显高于对照组(n=45)(859.50±495.44 vs 345.56±216.55 pg/ml)， P=0.001;(759.25±907.07 vs 197.45±249.31 pg/ml)， P=0.001。末次随访时iPTH值(198.26±155.22)pg/ml仍高于正常参考值(15.0 ~ 65.0 pg/ml)。多因素逐步回归分析显示，末次iPTH与术前iPTH、血清钙、术后血清磷、ALP、25OHD3相关(P=0.024, P=0.002, P=0.001, P=0.037, P=0.026)。结论肾受者iPTH水平升高，伴持续性高钙、低磷血症、骨质疏松、骨外钙化，表现为三期甲状旁腺功能亢进的特征。关键词:肾移植;三级甲状旁腺功能亢进;血钙过多;骨质疏松症

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Chineae Journal of Organ Transplantation

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