Surgical Treatment of Hyperparathyroidism in Children with Chronic Kidney Disease. Experience in 15 Patients

Presentation Number: MON 351
Date of Presentation: April 3rd, 2017

Silvia Gil*1, Gisela Lorena Viterbo1, Valeria De Dona1, Maria Adragna2, Juan Carlos Lopez2, Victor Ayarzabal,1 and Alicia Belgorosky1
1Hospital de Pediatria Garrahan, Argentina, 2Hospital de Pediatria Garrahan

Abstract

Secondary hyperparathyroidism (HPTs) is an important contributor to bone disease and cardiovascular calcifications in children with chronic kidney disease (CKD). When conservative measures (pharmacological and dietary interventions) are ineffective, parathyroidectomy is indicated. However, the results of this treatment have not yet been well evaluated in children.

We retrospectively analyzed the course of 15 pediatric CKD patients on dialysis with refractory HPTs (PTH > 800 pg/ml for more than 6 months) who underwent subtotal parathyroidectomy (PTXs) in our institution between 2010 and 2015. Nine males and 6 females were included; mean age (± SD): 14.3 ± 1.3 years (range 11.9–17).

All patients had clinical, radiological and biochemical signs of renal osteodystrophy. PTH had a significative positive correlation with alkaline phosphatase (ALP) (p 0.04). PTXs was successful in all but 1 patient, who required percutaneous ethanol injection 2 years later. None patients had postoperative complications. Serum PTH levels decrease 83.5% at 20 minutes post sPTX (p<0.001) with a positive predictive value of 92.8%. Due to severe hungry bone, oral calcium supply after surgery was 256 ± 121 mg/kg/day and calcitriol was 115 ± 70 ng/kg/day. None of the patients required phosphate supplementation. Median (interquartile range) serum PTH levels dropped within one year after PTXs from 1786 (1255-2430) to 143 pg/ml (95-247) p<0.001, serum ALP (X ± SD) from 1513 ± 969 to 330 ± 195 IU/l (p=0.002), Ca*P from 53 ± 14.3 to 44.8 ± 10.6 mg2/dl2 (p=0.006).Mean (X ± SD) Haemoglobin levels increase from 8.7 ± 1.3 to 11.1 ± 1.3 g/l (p<0.001). Histological findings showed a high correlation with pre-operative parathyroid ultrasound imaging (n=11,100%) and with 99Tc Sestamibi scintigraphy (n=12, 83.3%). Patient days mean(±) value was 7.5 ± 4.4. All patients improved clinical and radiological signs of bone disease. Four of them, who previously were wheelchair-bounded, started walking after PTXs. Mean weight/height ratio increase from 93.3 ± 11.8 to 100 ± 9% in one year post PTXs, p=0.02.

Pediatric PTXs is an effective and safe treatment to control HPTs and calcium-phosphate metabolism in children with CKD on dialysis and may mitigate unreversible bone deformities and progression of cardiovascular disease.

 

Nothing to Disclose: SG, GLV, VD, MA, JCL, VA, AB