Histology and immunohistochemistry of the parathyroid glands in renal secondary hyperparathyroidism refractory to vitamin D or cinacalcet therapy.

BACKGROUND: Cinacalcet is a new effective treatment of secondary hyperparathyroidism (SHPT) in hemodialysis patients (HP), but the alterations of parathyroid gland (PTG) hyperplasia determined by cinacalcet and vitamin D have not been extensively investigated in humans. METHODS: We performed histological analyses of 94 PTGs removed from 25 HP who underwent parathyroidectomy (PTx) because of SHPT refractory to therapy with vitamin D alone (group A=13 HP and 46 PTGs) or associated with cinacalcet (group B=12 HP and 48 PTGs). The number, weight, the macroscopic cystic/hemorrhagic changes, and type of hyperplasia of PTG (nodular=NH, diffuse=DH) were assessed. In randomly selected HP of group A (4 HP and 14 PTGs) and group B (4 HP and 15 PTGs), the labeling index of cells positive to Ki-67 and TUNEL and the semiquantitative score of immunohistochemistry staining of vitamin D receptor, calcium-sensing receptor, and vascular endothelial growth factor-α (VEGF-α) were measured in the entire PTGs and in the areas with DH or NH. RESULTS: The number and weight of single and total PTG of each HP were similar in the two groups as well as the number of PTG with macroscopic cystic/hemorrhagic areas. TUNEL, Ki-67, and VEGF-α scores were higher in NH than in DH areas. CONCLUSION: This observational study of a highly selected population of HP, submitted to PTx because SHPT refractory to therapy, shows that the macroscopic, microscopic, and immunochemistry characteristics of PTG in HP who received or did not receive cinacalcet before PTx did not differ significantly.

Variables associated with time of recovery after hemodialysis.

BACKGROUND: The aim of this study was to evaluate the relationship among time of recovery after hemodialysis (TIRD) and the demographic, social, clinical and laboratory characteristics of hemodialysis patients of a Mediterranean country. METHODS: One hundred hemodialysis patients were invited to answer the following question: "How long does it take you to recover from a dialysis session?" Demographic, clinical (Charlson Comorbidity Index [CCI], Mini-Mental State Examination [MMSE] and Geriatric Depression Scale [GDS]) and laboratory variables were recorded, and fatigue qualities (FQs) were assessed through 5 questions: Do you feel tired much of the time? (general); Do you feel that life is empty? (emotional); Do you have trouble concentrating? (cognitive); Do you have difficulty sleeping? (sleepiness); Do you have muscle weakness? (weakness); and Do you feel full of energy? (lack of energy). RESULTS: The means ± SD of TIRD was 205.5 ± 198.6 minutes: 79 patients reported a TIRD