Nephrol Dial Transplant (2002) 17: 1553-1557
© 2002 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
Management of patients with advanced secondary hyperparathyroidism: the Japanese approach
ROD-21 Clinical Research Group, Japan
Keywords: calcitriol pulse therapy; hyperparathyroidism; parathyroidectomy; parathyroid hyperplasia; percutaneous ethanol injection therapy; ultrasonography
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Introduction
Control of secondary hyperparathyroidism is one of the main objectives in the management of uraemic bone disease [1]. Although early initiation of prophylactic measures and calcitriol pulse therapy [2] in cases with advanced hyperparathyroidism have had a positive impact on patient management, there are still difficulties to select the most appropriate therapy for the individual patient with advanced secondary hyperparathyroidism. The major problem is to identify in time the patient who cannot be controlled by calcitriol and for whom the decision has to be made whether medical management or parathyroidectomy are the most appropriate interventions [3,4]. Despite advances, such as new vitamin D sterols [5], calcimimetics [6,7] or non-aluminium, non-calcium-containing phosphate binders [8], this dilemma persists unabated.
We are of the opinion that recent insights into the pathogenetic mechanisms underlying parathyroid hyperplasia [9
How to assess the patient
Which pathomechanisms underly parathyroid hyperplasia?
How does parathyroid gland morphology impact on patient management?
Selection of therapeutic modalities according to the pattern of parathyroid hyperplasia
The patient with suspected diffuse hyperplasia
The patient with suspected nodular hyperplasia
Conclusion
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Connotea 
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