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Vol. 30 - Jan/Feb/Mar de 2008

Article

Pages 51 to 56

Parathyroidectomy - Up-to-date to the Nephrologist
Paratireoidectomia - Atualização para o Nefrologista

Authors: Leandro Junior Lucca1, Luiz Carlos Conti de Freitas2


How to cite this article



ABSTRACT:
The secondary hyperparathyroidism is a common complication of chronic kidney disease, having an influence on mortality and quality-of life of patients. Clinical strategies of treatment not always reach the expected results, and the surgical treatment, parathyroidectomy, is frequently necessary. The progress in knowledge of pathogenesis, histopathology and pathophysiology of secondary hyperparathyroidism in chronic kidney disease has substantially influenced the decisions regarding the surgical procedures. The number of patients demanding surgical treatment increased considerably. The surgical parathyroidectomy has been broadly described, however, an evidence based best way of treatment is still missing. Nowadays, the pharmacological parathyroidectomy appears as a new possibility of treatment, but data are still very inconsistent. This paper presents a brief historical report with a focus on the best way to treat patients based on the literature suggesting a better standardization of follow-up and treatment. It also encourages new centers to assemble groups devoted to study the subject and to accomplish the surgical procedures.

Descriptors:
Chronic kidney disease. Secondary hyperparathyroidism. Parathyroidectomy.

RESUMO:
O hiperparatireoidismo secundário é uma complicação comum nos pacientes com doença renal crônica(DRC), influenciando a morbidade e a mortalidade desses pacientes. Estratégias clínicas de tratamento nem sempre alcançam o resultado esperado, e freqüentemente recorre-se ao tratamento cirúrgico, a paratireoidectomia. Os avanços no conhecimento da fisiopatologia do hiperparatireoidismo secundário influenciam as condutas clinicas e cirúrgicas. O número de pacientes necessitando de tratamento cirúrgico tem aumentado assustadoramente. A paratireoidectomia cirúrgica tem sido utilizada amplamente, entretanto, é necessário definir o melhor tratamento baseando-se em evidências. A paratireoidectomia farmacológica representa uma nova possibilidade terapêutica, porém, com resultados ainda bastante controversos. Este trabalho apresenta um panorama histórico da literatura vigente, visando melhor padronização das condutas e do seguimento dos pacientes, além de estimular novos centros e grupos de estudo a se lançarem no tratamento cirúrgico.

Descritores:
Insuficiência renal crônica. Hiperparatireodismo Secundário. Paratireoidectomia.


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