Clinical guidelines and PTH measurement: does assay generation matter?

Clinical guidelines and PTH measurement: does assay generation matter? Endocr Rev. 2019 May 13;: Authors: Smit MA, van Kinschot CMJ, van der Linden J, van Noord C, Kos S Abstract Parathyroid hormone (PTH) is an important regulator of calcium and phosphate homeostasis and bone remodeling. PTH is metabolized into PTH fragments which are measured to a different extent by PTH assays of different generations. This is due to differences in fragments recognized and lack of assay standardization. PTH is measured in the workup of several conditions and clinical guidelines provide recommendations concerning these measurements. This review provides an overview of the impact of differences between PTH assays, when applying distinct clinical guidelines for primary and secondary hyperparathyroidism and perioperative use of PTH measurements. Guidelines deal with PTH measurement in different ways, recommending either trend monitoring, the use of a fold-increase of the upper reference limit, or state an absolute PTH cut-off value. For classic primary hyperparathyroidism (PHPT) the type of PTH assay used will not affect diagnosis or management as the precise concentration of PTH is less relevant. In chronic kidney disease (CKD), the guideline recommends treatment of secondary hyperparathyroidism (SHPT) above a 2-9-fold PTH increase, which will result in different clinical decisions, dependent on the assay used. For patients after bariatric surgery guidelines state absolute...
Source: Endocrine Reviews - Category: Endocrinology Tags: Endocr Rev Source Type: research

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ConclusionAlthough the progress of medical treatment is changing rapidly, surgical treatment is still an effective way to control serum iPTH and calcium chronically for SHPT patients. Complex SHPT patients can also receive satisfied effect by surgical treatment, without apparently increasing the risk of complications.
Source: American Journal of Otolaryngology - Category: Endocrinology Source Type: research
AbstractSecondary and tertiary hyperparathyroidism is an important problem of chronic kidney disease. Brown tumor is a benign, unusual, reactive lesion as a result of disturbed bone remodeling, from long-standing increase in parathyroid hormone level. Brown tumors may cause morbidity due to pressure symptoms on neural structures and spontaneous bone fractures. Herein, we presented a peritoneal dialysis patient with tertiary hyperparathyroidism under calcand calcitriol treatment for 4  years due to refusing of the parathyroidectomy operation. She admitted to hospital for sudden onset back pain with difficulty in gait a...
Source: CEN Case Reports - Category: Urology & Nephrology Source Type: research
Publication date: Available online 2 May 2019Source: Urology Case ReportsAuthor(s): Amulya Cherukumudi, Suraj Hegde, T.P. Rajeev, Narendra Pai, Amit Kumar, Gaurav KalraAbstractGangrene of the penis in patients with chronic kidney disease undergoing haemodialysis is a rare occurrence. Such patients often have associated comorbidities such as type II diabetes mellitus and systemic hypertension, along with secondary hyperparathyroidism leading to dystrophic calcification. These conditions accelerate the process of atherosclerosis, which, along with calcium deposition, causes partial or complete obstruction of the blood vessel...
Source: Urology Case Reports - Category: Urology & Nephrology Source Type: research
CONCLUSIONS: The effectiveness of cinacalcet were still obviously demonstrated even in chronic HD patients with severe SHPT. In addition, the improvements of bone markers and FGF-23, and stabilization of vascular calcification were observed. Therefore, cinacalcet can provide salutary effects on CKD-MBD in severe SHPT and might be an initially effective PTH-lowering therapy prior to surgical parathyroidectomy as well as an alternative treatment in the patients unsuitable for surgery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT02056730. Date of registration: February 4, 2014. PMID: 31014177 [PubMed - in process]
Source: Renal Failure - Category: Urology & Nephrology Tags: Ren Fail Source Type: research
Fight Aging! provides a weekly digest of news and commentary for thousands of subscribers interested in the latest longevity science: progress towards the medical control of aging in order to prevent age-related frailty, suffering, and disease, as well as improvements in the present understanding of what works and what doesn't work when it comes to extending healthy life. Expect to see summaries of recent advances in medical research, news from the scientific community, advocacy and fundraising initiatives to help speed work on the repair and reversal of aging, links to online resources, and much more. This content is...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
Calcimimetics are widely used in patients on dialysis to treat secondary hyperparathyroidism. Our current view is that bone effects are only indirect through parathyroid hormone suppression. However, because bone cells express the calcium-sensing receptor, direct calcium-sensing receptor –mediated effects are also possible. New experimental data demonstrate direct anabolic bone actions of calcimimetics, independent of parathyroid hormone suppression. Because these effects could be clinically useful, further studies are necessary to confirm the validity of this observation.
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Commentary Source Type: research
CONCLUSIONS: Treatment with ferric citrate attenuated renal failure and cardiovascular abnormalities including myocardial hypertrophy and fibrosis in CKD rats. PMID: 30988246 [PubMed - in process]
Source: Iranian Journal of Kidney Diseases - Category: Urology & Nephrology Tags: Iran J Kidney Dis Source Type: research
The link between age-related kidney dysfunction and cognitive impairment is an interesting one, particularly in the context of research into klotho, which has functions in both the kidney and the brain, and has been shown to extend life and improve cognitive function in animal studies. It isn't completely clear as to which of these areas of the body is most important to the noted benefits to cognitive function in animal models, produced via various strategies for klotho overexpression. The most recent research on this topic tends to suggest that the mechanisms are indirect, involving many organ systems, rather than being a...
Source: Fight Aging! - Category: Research Authors: Tags: Daily News Source Type: blogs
We built a model of the parathyroid gland biology in hemodialysis patients based on the regulation of the calcium ‐sensing receptor. The model spans several timescales, from the fast release of parathyroid hormone in the case of induced hypocalcemia to the development of cell hyperplasia in the case of reduced phosphate clearance and impaired vitamin D metabolism. The model provides a ready‐to‐use tool to analyze the complex system underlying secondary hyperparathyroidism. AbstractAltered parathyroid gland biology in patients with chronic kidney disease (CKD) is a major contributor to chronic kidney disease ‐minera...
Source: Physiological Reports - Category: Physiology Authors: Tags: Original Research Source Type: research
Authors: Lioufas N, Hawley CM, Cameron JD, Toussaint ND Abstract Chronic kidney disease (CKD) is associated with excess cardiovascular mortality, resulting from both traditional and nontraditional, CKD-specific, cardiovascular risk factors. Nontraditional risk factors include the entity Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) which is characterised by disorders of bone and mineral metabolism, including biochemical abnormalities of hyperphosphatemia and hyperparathyroidism, renal osteodystrophy, and vascular calcification. Increased arterial stiffness in the CKD population can be attributed amongs...
Source: International Journal of Hypertension - Category: Cardiology Tags: Int J Hypertens Source Type: research
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