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Allgemein- und Viszeralchirurgie up2date 2016; 10(02): 73-85
DOI: 10.1055/s-0041-106361
Endokrine Chirurgie
Georg Thieme Verlag KG Stuttgart · New York

Sekundärer Hyperparathyreoidismus

C. Dotzenrath
HELIOS Klinikum Wuppertal
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Publication Date:
13 April 2016 (online)

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Der renale Hyperparathyreoidismus (rHPT) ist eine häufige Komplikation der chronischen Niereninsuffizienz. Die weltweit steigende Zahl der Dialysepatienten verbunden mit einer längeren Lebenserwartung hat die Therapie des rHPT zunehmend zu einem relevanten medizinischen und sozioökonomischen Problem gemacht. Die Therapie wird kontrovers diskutiert: Unstrittig ist die Nierentransplantation (NTP) als die einzige Kausaltherapie. Der Einsatz neuer Therapeutika (kalzium- und aluminiumfreie Phosphatbinder, das Kalzimimetikum Cinacalcet und aktive Vitamin-D3-Analoga haben zu einem deutlichen Rückgang der Nebenschilddrüsenoperationen geführt. Bei Patienten, die trotz medikamentöser Therapie einen schweren biochemischen Hyperparathyreoidismus mit klinischen Symptomen zeigen, z. B. schwere renale Osteopathie, Frakturen, Weichteil- oder Gefäßverkalkungen oder Kalziphylaxie, ist die Operation meistens die einzige therapeutische Option. Mehrere Operationsverfahren werden angewandt. Allerdings sind Persistenz- und Rezidivraten hoch, was zum Teil auch auf den natürlichen Verlauf der Erkrankung zurückzuführen ist.

 

    • Literatur

    • 1 Deutsche Gesellschaft für Nephrologie. Das Nierenportal. Im Internet: http://www.dgfn.eu/presse/downloadbereich/dialyse.html Stand: 08.01.2016
    • 2 Chertow GM, Block GA, Correa-Rotter R et al. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis. N Engl J Med 2012; 367: 2482-2494
      CrossrefPubMedSearch in Google Scholar
    • 3 National Kidney Foundation. KDOQI Clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003; 42: S1-S201
      PubMedSearch in Google Scholar
    • 4 Kidney Disease: Improving global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2009; 113: S1-130
      Search in Google Scholar
    • 5 Guideline working group, Japanese Society for Dialysis Therapy. Clinical practice guidelines for management of secondary hyperparathyroidism in chronic dialysis patients. Ther Apher Dial 2008; 12: 514-525
      CrossrefSearch in Google Scholar
    • 6 Tominaga Y, Matsuoka S, Uno N et al. Removal of autografted parathyroid tissue for recurrent renal hyperparathyroidism in hemodialysis patients. World J Surg 2010; 34: 1312-1317
      CrossrefSearch in Google Scholar
    • 7 Lorenz K, Ukkat J, Sekulla C et al. Total parathyroidectomy without autotransplantation for renal hyperparathyroidism: experience with a qPTH-controlled Protocol. World J Surg 2006; 30: 743-751
      CrossrefSearch in Google Scholar
    • 8 Wells Jr SA, Gunnells JC, Shelburne JD et al. Transplantation of parathyroid glands in man: clinical indications and results. Surgery 1975; 78: 33-44
      Search in Google Scholar
    • 9 Schlosser K, Veit JA, Witte S et al. Comparison of total parathyroidectomy without autotransplantation and without thymectomy versus total parathyroidectomy with autotransplantation and with thymectomy for secondary hyperparathyroidism: TOPAR PILOT-Trial. Trials 2007; 18: 22
      Search in Google Scholar
    • 10 Brunt LM, Wells Jr. SA. Surgical treatment of secondary hyperparathyroidism. Ann Chir Gynaecol 1983; 72: 139-145
      Search in Google Scholar
    • 11 Saxe A. Parathyroid transplantation: a review. Surgery 1984; 95: 507-526
      Search in Google Scholar
    • 12 Dubost C, Kracht M, Assens P et al. Reoperation for secondary hyperparathyroidism in hemodialysis patients. World J Surg 1986; 10: 654-660
      CrossrefSearch in Google Scholar
    • 13 Henry JF, Denizot A, Audiffret J et al. Results of reoperations for persistent or recurrent secondary hyperparathyroidism in hemodialysis patients. World J Surg 1990; 14: 303-307
      CrossrefSearch in Google Scholar
    • 14 Tanaka Y, Seo H, Tominaga Y et al. Factors related to the recurrent hyperfunction of autografts after total parathyroidectomy in patients with severe secondary hyperparathyroidism. Surg Today 1993; 23: 220-227
      CrossrefSearch in Google Scholar
    • 15 Hibi Y, Tominaga Y, Sato T et al. Reoperation for renal hyperparathyroidism. World J Surg 2002; 26: 1301-1307
      CrossrefSearch in Google Scholar
    • 16 Dotzenrath C, Cupisti K, Goretzki P et al. Operative treatment of renal autonomous hyperparathyroidism: cause of persistent or recurrent disease in 304 patients. Langenbecks Arch Surg 2003; 387: 348-354
      Search in Google Scholar
    • 17 Low TH, Clark J, Gao K et al. Outcome of parathyroidectomy for patients with renal disease and hyperparathyroidism: predictors for recurrent hyperparathyroidism. ANZ J Surg 2009; 79: 378-382
      CrossrefSearch in Google Scholar
    • 18 Schneider R, Slater EP, Karakas E et al. Initial parathyroid surgery in 606 patients with renal hyperparathyroidism. World J Surg 2012; 36: 318-326
      CrossrefSearch in Google Scholar

    • Zum Weiterlesen und Vertiefen

    • 19 Block GA, Hulbert-Shearon TE, Levin NW et al. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 1998; 31: 607-617
      CrossrefSearch in Google Scholar
    • 20 Chang T, Abdalla S, London GM et al. The effect of cinacalcet on blood pressure, mortality and cardiovascular endpoints in the EVOLVE trial. J Hum Hypertens 2015; [Epub ahead of print]
      Search in Google Scholar
    • 21 Dotzenrath C. Indikation zur operativen Therapie des renalen Hyperparathyreoidismus. Chirurg 2010; 81: 902-908
      CrossrefSearch in Google Scholar
    • 22 Ketteler M. Phosphatbinder, Vitamin D, Cinacalcet. Therapierichtlinien. Nephrologe 2008; 3: 96-107
      CrossrefSearch in Google Scholar
    • 23 Lorenz K, Bartsch DK, Sancho JJ et al. Surgical management of secondary hyperparathyroidism in chronic kidney disease – a consensus report of the european society of Endocrine Surgeons. Langenbecks Arch Surg 2015; [Epub ahead of print]
      Search in Google Scholar
    • 24 Moe S, Drüeke T, Cunningham J et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2006; 69: 1945-1953
      CrossrefSearch in Google Scholar
    • 25 National Institute of Health and Clinical Excellence (NICE). Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end stage renal disease on maintenance dialysis therapy. Im Internet: http://www.nice.org.uk Stand: 08.01.2016
    • 26 Riss P, Asari R, Scheuba C et al. Current trends in surgery for renal hyperparathyroidism (RHPT) – an international survey. Langenbecks Arch Surg 2013; 398: 121-130
      CrossrefSearch in Google Scholar
    • 27 Schlosser K, Endres N, Celik I et al. Surgical treatment of tertiary hyperparathyroidism: the choice of procedure matters!. World J Surg 2007; 31: 1947-1953
      CrossrefSearch in Google Scholar
    • 28 Schneider R, Bartsch DK. Role of surgery in the treatment of renal secondary hyperparathyroidism. Br J Surg 2015; 102: 289-290
      CrossrefSearch in Google Scholar