Surgical treatment for renal hyperparathyroidism--report of 23 cases.

The present study describes surgical resection in 23 patients under maintenance hemodialysis with hyperparathyroidism. Twenty-three patients under maintenance hemodialysis had subtotal parathyroidectomy (s-PTx, n = 12) or parathyroid gland transplantation combined with total parathyroidectomy (Tx, n = 11) performed from January 1979 to January 1991. Their ages ranged from 8 to 63 years. The PTH levels were elevated in all patients preoperatively from 2.5 to 120 times over the upper limit of normal. After s-PTx, PTH levels sharply declined in all but one patient. Clinical symptoms improved in 11 cases with PTH decrease. After Tx, an abrupt decline in PTH was observed after surgery in 10 patients. One patient was reoperated because of persistent hyperparathyroidism. Another patient showed a PTH increase 13 months after surgery. The transplanted parathyroid gland was subtotally resected. Five months after reoperation, the condition recurred and the patient underwent total resection of the transplanted parathyroid gland and its re-autografting into the forearm. In the patients with renal hyperparathyroidism, s-PTx or Tx improved clinical symptoms; this indicates the high reliability of both procedures in treating the disease. A long-term follow-up study must be conducted to check the possible postoperative recurrence of hyperparathyroidism from residual and/or autograft parathyroid gland.