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Basic and clinical aspects of parathyroid hyperplasia in chronic kidney disease

机译：慢性肾脏病甲状旁腺增生的基本和临床方面

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Marked parathyroid hyperplasia develops in patients with chronic kidney disease, especially those with long dialysis vintage. Although progression of hyperplasia is associated with downregulation of vitamin D receptor and calcium-sensing receptor, initial abnormality that triggers and maintains parathyroid cell proliferation, as well the critical abnormality for the progression of diffuse hyperplasia to nodular hyperplasia, still remains to be elucidated. It is quite important for the optimal management of renal osteodystrophy to recognize the development of nodular hyperplasia, because the cells in nodular hyperplasia are usually resistant to medical therapy and further treatment of such patients often leads to vascular calcification. For this purpose, size and blood supply of enlarged parathyroid glands have been used as good clinical markers. Furthermore, we have recently shown that the serum fibroblast growth factor 23 level can be used for predicting refractory hyperparathyroidism. Once nodular hyperplasia develops in any of the enlarged parathyroid glands, such patients need to be treated by parathyroid intervention including percutaneous ethanol injection therapy. In addition, as direct vitamin D injection therapy has been shown to induce regression of hyperplasia, it may become possible to reverse or normalize established nodular hyperplasia if we can develop new agents with such effects in the near future.
机译：患有慢性肾脏疾病的患者，尤其是透析期较长的患者，会出现明显的甲状旁腺增生。尽管增生的进展与维生素D受体和钙敏感受体的下调有关，但引发和维持甲状旁腺细胞增殖的初始异常，以及弥漫性增生向结节性增生进展的关键异常，仍有待阐明。认识到结节性增生的发展对于最佳管理肾骨营养不良非常重要，因为结节性增生中的细胞通常对药物治疗有抵抗力，对此类患者的进一步治疗通常会导致血管钙化。为此，甲状旁腺增大的大小和血液供应已被用作良好的临床指标。此外，我们最近显示血清成纤维细胞生长因子23水平可用于预测难治性甲状旁腺功能亢进。一旦在任何扩大的甲状旁腺中出现结节性增生，就需要通过甲状旁腺干预（包括经皮乙醇注射疗法）治疗此类患者。另外，由于直接维生素D注射疗法已显示出可导致增生的消退，如果我们能在不久的将来开发出具有这种作用的新药物，则有可能逆转或正常化已确立的结节性增生。

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