Renal Failure after Surgery for Primary Hyperparathyroidism: Is Acute Reduction of Parathyroid Function a Risk Factor?

A possible deleterious effect of parathyroidectomy on renal allograft function has been discussed in recent literature. Schwarz et al. observed a correlation between acute kidney dysfunction and the degree of parathyroid hormone (PTH) reduction following a parathyroidectomy for tertiary hyperparathyroidism (HPT). This effect seems to be in contrast to some physiological studies demonstrating that injection of PTH is associated with a reduction in the glomerular capillary ultrafiltration coefficient (Kf). Based on this evidence, the acute reduction in PTH would theoretically improve glomerular filtration. In general, the reversal of HPT would prevent further renal damage. Stable or improved renal function are the observed clinical courses for most patients in the longrun, but we observed a different pattern during the first 48 hours after the operation, with a transitory increase in creatinine levels above 10% in 77 of 105 patients after parathyroidectomy for primary HPT. Creatinine levels increased more than 50% in 18 patients (17.1%). In renal stone patients, a slight increase in creatinine after successful resection of a parathyroid adenoma was recently commented. The elevation of creatinine was transient and clinically silent in most of our patients. However, acute deterioration of renal function requiring dialysis occurred in two of 183 (1.1%) patients with primary HPT who underwent surgery from 1997 to 2007. The outcome of these cases may indicate a potentially relevant role of the parathyroid glands in renal regulation. CASE REPORTS