Secondary hyperparathyroidism. Specific features, complexity, features of treatment. Literature review. Part II - Surgical treatment

Secondary hyperparathyroidism is a common and serious complication of chronic kidney disease (CKD) in both dialysis and predialysis patients. Progression of chronic kidney disease with a loss of active nephrons and interstitial fibrosis lead to a cascade of complications, including vitamin D deficiency, hyperphosphatemia, decreased calcium absorption, and increased production of parathyroid hormone. Advance development of drug therapy, targeting various components of hyperparathyroidism (HPT) pathogenesis, and in particular, the advent of calcimimetics, significantly reduced the number of patients with uncontrolled HPT. However, a substantial proportion of patients are drug-resistant, and therefore need surgical correction of HPT. Parathyroidectomy has been widely reported to improve bone mineral density, reduce the risk of fractures, and improve the quality of life and survival of dialysis patients. The review is devoted to the most pressing and controversial issues of surgical treatment of secondary HPT. The topics addressed in the review are as follows: 1) indications for surgical correction are presented according to various clinical National guidelines; 2) issues of preoperative topical localization of the parathyroid glands and its influence on the surgery outcomes; 3) comparative analysis of the sensitivity and specificity of various imaging technics (ultrasound, scintigraphy, computed tomography) alone or in combination; 4) controversial issues of choosing the most optimal extent of surgery. Current available literature does not provide consensus about optimal for this highly comorbid group of patients. This review provides information on modern surgical treatment options, their advantages and disadvantages. As a rule, subtotal parathyroidectomy is associated with a higher risk of disease relapse, while severe hypocalcemia more often observed after a total parathyroidectomy. The choice of the extent of surgical intervention is considered in view of the HPT recurrence rate, predicted life expectancy, and perspective of kidney transplantation. Possible postoperative complications are described. Thus, the problems of examining and treating patients with CKD stage 5 and secondary HPT remain relevant.

хроническая болезнь почек, вторичный гиперпаратиреоз, околощитовидные железы, паратиреоидэктомия, chronic kidney disease, secondary hyperparathyroidism, parathyroid gland, parathyroidectomia

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