ABSTRACT
Secondary hyperparathyroidism is the condition is which parathyroid hormone(PTH) is over secreted to compensate for a chronically low serum calcium level and chronic renal failure is the most common cause. In 1934, Albreight reported an association between hyperparathyroidism and the chronic renal failure and in 1960, Stanbury first reported subtotal parathyroidectomy for the treatment of secondary hyperparathyroidism. The physiologic mechanism leading to secondary hyperparathyroidism in the chronic renal failure are well known and relatively well controled with medical management, but sometimes may necessitate surgical intervention in medically intractable cases. In Korea, the surgery for secondry hyperparathyroidism is not frequently performed yet as in western countries. We experienced two cases of secondary hyperparathyroidism recently and report its results of subtotal parathyrodiectomy.
Subject(s)
Calcium , Hyperparathyroidism , Hyperparathyroidism, Secondary , Kidney Failure, Chronic , Korea , ParathyroidectomyABSTRACT
BACKGROUND: Kidney transplantation is now an accepted form of treatment for chronic renal failure. However, the necessary and prolonged use of immunosuppressive agents result in various complications. OBJECTIVE: The aim of the present study was to see what the mucocutaneous manifestations would be and how they develop in renal transplant recipients treated with immunosuppressants. METHODS: 187 patients who were examined in dermatology among kidney transplant recipients at Asan Medical Center between June 19S9 and August 1998 were included in this study. The clinical records were reviewed, physical examinations were conducted and the cultures or histological examinations were done when indicated. RESULTS: The most common findings in the skin of the renal transplant recipients were hypertrichosis and Cushingoid changes. The incidence of warts was 22%. There were three cases of Kaposis sarcoma, Bowens diseases, and porokeratosis. CONCLUSIONS: The incidence of skin cancers and precancerous lesions was lower than other countries, but cosmetic and functional complications of immunosuppression are frequent. Therefore, it is essential that all renal transplant recipients should be provided with initial and continuing periodic examinations by dermatologists.
Subject(s)
Humans , Dermatology , Hypertrichosis , Immunosuppression Therapy , Immunosuppressive Agents , Incidence , Kidney Failure, Chronic , Kidney Transplantation , Kidney , Physical Examination , Porokeratosis , Sarcoma, Kaposi , Skin , Skin Neoplasms , Transplantation , WartsABSTRACT
The Fanconi syndrome is a complex tubulopathy, which is characterized by urinary hyperexcretion of amino acids of all classes, phosphate, glucose, bicarbonate, calkium, potassium, and otherions, and proteins with molecular weights under 50,000 daltons. This metabolic disease leads to hypophospatemia, hypokalemia, growth failure, metabolic acidasis, and rickets/osteomalacia. Fanconi syndrome may be inherited or acqulred. Most cases of adult Fanconi syndrome are acquired, and the acquired syndrome is associated with thermal burns, exposure to heavy metals or drugs, vitmnin D deficiency, renal transplantation, or light chain deposition. The most common cause of adult Fanconi syndrome is multiple myeloma. We ribe here a case of adult Fanconi syndrome and osteomalacia associated with x-light chain monoclonal gammopathy. A 47-year-old woman presented with multiple bane pain and proximal muscle weakness for 2 years. Laboratory findmgs showed hypophosphatemia, mild hypocalcemia, marked elevation of serum alkaline phosphatase, metabolic acidosis, low 25-OH- vitamm D level and secondary hyperparathyroidism. Urinary excretion of protein, uric acid, phosphate, and glucose was mcreased, and tubular reabsorption of phosphate was decreased to 50%. Protein immunofixation electrophoresis of serum and urine showed x-light chain type monoclonal gammopathy. Bone marrow examination was normal except moderate elevation of plasma cell component(8.8%). The skeletal radiography showed fractures of both lower ribs and pseudofracture in right femoral lesser trochanter. We treated the patient with calcium, 1.25-(OH)2-vitamin D, phosphorus, bicarbonate, and potassium, and her clinical symptoms were gradually relieved.
Subject(s)
Adult , Female , Humans , Middle Aged , Acidosis , Alkaline Phosphatase , Amino Acids , Bone Marrow Examination , Burns , Calcium , Electrophoresis , Fanconi Syndrome , Femur , Glucose , Hyperparathyroidism, Secondary , Hypocalcemia , Hypokalemia , Hypophosphatemia , Kidney Transplantation , Metabolic Diseases , Metals, Heavy , Molecular Weight , Multiple Myeloma , Muscle Weakness , Osteomalacia , Paraproteinemias , Phosphorus , Plasma Cells , Potassium , Radiography , Ribes , Ribs , Uric AcidABSTRACT
No abstract available.
Subject(s)
Animals , Rats , Epidermal Growth Factor , Mesangial CellsABSTRACT
The purpose of this study was to examine the frequency of eutaneous disorders in patients with chronie renal failure presently on hemodialysis(HD). The results were as follows. 1. Cutaneous lesions were present in all 78(100% ) patients with chronic renal failure. 2. The frequency of msjor cutaneous problems associated with chronic renal failure was as follows: xerosis(82.1%), pruritus(74.4%), nail changes(74.4%), hyperpigmentation(70.5 % ), xerostomia(42.3'Yo), poor wound healing(37.2%), easy bruisability(30,8%), hypotrichosis(21.896), and purpura(14.1 % ). 3. Cutaneous problems which appeared after the initiation of HD were. appearance of new pigmented nevi or lentigines(9 patients), appearance or aggravation of acne(6), contact dermatitis at AV fistula site(2), gynecomastia(1), extensive flat warts(1), extensive tinea versicolor(1), and extensive vitiligo(1). 4. Among 55 patients with hyperpigmentation, 11 patients reported decreased pigmentation following HD. In 15 patients, hyperpigmentation worsened following HD, and in 9 patients hyperpigmentation first appeared after HD was initiated. 5. Cutaneous disorders favorably affected by HD were as follows: easy bruisability(3/ 24), xerostomia(3/33), gingival friability(2/7), and hypotrichosis(5/17). 6. Poor wound healing and xerosis were not improved by HD. 7. Among 58 pruritic patients, 7 patients were improved after HD, 7 patients became worse during each HD, and 3 patients were not pruritic only for 2 to 3 days after each HD. Four patients experinced pruritus only during each HD. 8. There was no significant statistical difference between the frequency of pruritus and xerosis and the levels of blood urea nitrogen, calcium, phosphorus, and parathyroid hormone.