Surgical treatment of secondary hyperparathyroidism: factors affecting the function of auto-implant

• Grant number: 12/01233-6
• Support Opportunities: Regular Research Grants
• Start date: June 01, 2012
• End date: May 31, 2015
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Vanda Jorgetti
• Grantee: Vanda Jorgetti
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Associated researchers: Ana Karenina Nobre Fonseca ; Fábio Luiz de Menezes Montenegro ; Luciene Machado dos Reis ; Melani Ribeiro Custódio ; Rodrigo Bueno de Oliveira ; Rosa Maria Affonso Moysés ; Roxana de Fátima Camelo de Albuquerque ; Sérgio Samir Arap

Abstract

Chronic Kidney Disease (CKD) is a metabolic syndrome resulting from the progressive, irreversible and often slow loss of kidney function. Disorders of mineral metabolism resulting from CKD stimulate the parathyroid glands resulting in hyperplasia, increased secretion of PTH and secondary hyperparathyroidism (HPS). When the clinical treatment of HPS fails, the last resort is parathyroidectomy (PTx). Currently, the most often performed surgery is PTx with AI (autoimplantation) of parathyroid tissue. Further studies are still necessary to assess factors such as the amount of tissue implanted and determine whether the medications used in the period of hungry bone could affect autoimplantation. Objectives: 1 - To determine whether the number of fragments used in autoimplantation and the medications used in the period of bone hunger influence the recurrence of HPS or the development of hypoparathyroidism. 2-To analyze the anatomopathological characteristics of the glands obtained at surgery, especially of the one used in autoimplantation, and the presence of diffuse and/or nodular proliferation, as well as the level of cell proliferation analyzed by PCNA expression. To further evaluate whether the expression of FGF-23, Klotho protein, VDR, Ca receptor, FGF-23 (FGFR1c) and Pit-1 receptors influence the functioning of AI. 3 - To evaluate the functionality of autoimplantation within a one-year follow-up period as well as outcomes such as recurrence, hypoparathyroidism, fractures, bone pain and survival. Patients and Methods: A clinical, observational, prospective and randomized study, with a 12-month follow-up, involving 50 patients with CKD and HPS indicating PTx. The study will involve outpatients from the Renal Osteodystrophy Department of the Nephrology Service of the HC-FMUSP and the surgery will be performed by the Surgery Department of Head and Neck of the HC-FMUSP. The patients will be randomized into 2 groups: with autoimplantation of 45 or 90 fragments. Demographic and biochemical characteristics of the patients will be analyzed in the pre- and postoperative periods. The glands will be submitted to anatomopathological analysis and immunohistochemistry. (AU)