Our Summary

This research paper looks into whether removing the parathyroid glands (a surgery known as parathyroidectomy) can help improve kidney function in patients with primary hyperparathyroidism. Primary hyperparathyroidism is a disease where the parathyroid glands produce too much hormone, leading to problems like kidney stones and weak bones.

The researchers looked back at medical records between 2003 and 2017, and focused on patients with primary hyperparathyroidism who had the surgery. They followed up with these patients until the end of 2017, their death, or until they needed kidney replacement therapy.

The impact of the surgery on kidney function was measured using several methods, including changes in estimated glomerular filtration rate (eGFR) - a test used to check how well the kidneys are working.

The study found that although the surgery did not affect the amount of protein in the urine (a sign of kidney damage) or the spread of eGFR values, it did significantly slow down the rate at which kidney function declined. The surgery was even more beneficial for kidney function in patients under 65 and those without chronic kidney disease or high blood pressure.

The researchers concluded that removing the parathyroid glands can slow down the decline in kidney function, regardless of age or other health conditions. This could potentially change the guidelines on when to perform this surgery for primary hyperparathyroidism. However, they also note that their study only included a small number of patients, and more research needs to be done to confirm their findings.

FAQs

  1. What is the impact of parathyroidectomy on kidney function in patients with primary hyperparathyroidism?
  2. Does parathyroidectomy have a different effect on kidney function in patients under 65 years old and those without chronic kidney disease or hypertension?
  3. What further research is needed to confirm the findings of this study on parathyroidectomy and kidney function in patients with primary hyperparathyroidism?

Doctor’s Tip

A helpful tip a doctor might tell a patient about parathyroidectomy is to closely monitor their kidney function before and after the surgery. It is important to track changes in estimated glomerular filtration rate (eGFR) to assess the impact of the surgery on kidney function. Patients should also follow up with their healthcare provider regularly to ensure that their kidney function is stable and to address any concerns or changes in eGFR.

Suitable For

Patients with primary hyperparathyroidism who may benefit from parathyroidectomy include those with declining kidney function, nephrolithiasis, osteoporosis, and other deleterious effects on health. This study suggests that parathyroidectomy can slow the decline in renal function, particularly in patients under 65 years old and those without chronic kidney disease or hypertension. Further research is needed to confirm these findings and potentially revise guidelines for surgical indications in primary hyperparathyroidism.

Timeline

  • Before parathyroidectomy:
  1. Patient is diagnosed with primary hyperparathyroidism, which may have been discovered through symptoms such as fatigue, weakness, kidney stones, or bone pain.
  2. Patient undergoes initial evaluation, including blood tests to measure calcium and parathyroid hormone levels, imaging studies to locate the abnormal parathyroid gland, and possibly a bone density scan.
  3. Patient may experience symptoms related to high calcium levels, such as frequent urination, thirst, abdominal pain, and muscle weakness.
  4. Decision is made to proceed with parathyroidectomy as treatment for primary hyperparathyroidism.
  • After parathyroidectomy:
  1. Patient undergoes surgery to remove the abnormal parathyroid gland or glands.
  2. Patient is monitored postoperatively for any complications, such as low calcium levels (hypocalcemia) which may require calcium and vitamin D supplementation.
  3. Patient experiences gradual improvement in symptoms related to primary hyperparathyroidism, such as fatigue and muscle weakness.
  4. Follow-up visits are scheduled to monitor calcium and parathyroid hormone levels, kidney function, and bone health.
  5. Long-term benefits of parathyroidectomy on kidney function are observed, with a slower decline rate of estimated glomerular filtration rate (eGFR) compared to before surgery.
  6. Patients under 65 years old and those without chronic kidney disease or hypertension may experience greater beneficial effects on kidney function post-parathyroidectomy.
  7. Further large-scale controlled studies are recommended to confirm the findings and potentially revise guidelines for surgical indications in primary hyperparathyroidism.

What to Ask Your Doctor

  1. How will parathyroidectomy benefit my kidney function?
  2. What are the potential risks and complications associated with parathyroidectomy?
  3. How long is the recovery period after parathyroidectomy?
  4. Will I need to take any medications or make lifestyle changes after the surgery?
  5. How often will I need follow-up appointments after the surgery?
  6. Are there any alternative treatment options for primary hyperparathyroidism?
  7. Will parathyroidectomy affect my calcium levels or other hormone levels?
  8. How will parathyroidectomy impact my overall health and quality of life?
  9. What is the success rate of parathyroidectomy in improving kidney function in patients with primary hyperparathyroidism?
  10. Are there any specific factors, such as age or comorbidities, that may affect the outcome of parathyroidectomy in improving kidney function?

Reference

Authors: Liang CC, Yeh HC, Lo YC, Chou CY, Yen TH, Tsai HC, Hsu SP, Kuo CC. Journal: J Endocrinol Invest. 2021 Apr;44(4):755-763. doi: 10.1007/s40618-020-01369-4. Epub 2020 Jul 29. PMID: 32729050