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Nephrol Dial Transplant (2003) 18: III50-III52
© 2003 European Renal Association-European Dialysis and Transplant Association

Original Article

Surgical verification of percutaneous maxacalcitol injection therapy on enlarged parathyroid glands in chronic dialysis patients

Hiroyasu Yamamoto1,, Naohiko Katoh1, Hiroshi Takeyama2, Masato Ikeda1, Keitaro Yokoyama1, Takashi Shigematsu1, Yoshindo Kawaguchi1 and Tatsuo Hosoya1

1 Division of Nephrology and Hypertension, Department of Internal Medicine and 2 Department of Surgery, Jikei University School of Medicine, Tokyo, Japan

Selective percutaneous ethanol injection therapy (PEIT) has been used to control parathyroid function in patients with secondary hyperparathyroidism (2HPT) when one or more parathyroid gland (PTG) progresses to the nodular hyperplasia stage. However, PEIT can have adverse side effects, such as nerve paralysis and adhesion, because the ethanol is destructive. Intraparathyroid injection of a vitamin D analogue has been designed as a treatment to control parathyroid function without destruction of the PTG or causing adhesions to the surrounding tissue, and the present study aimed to verify the effect of percutaneous maxacalcitol (22-oxacalcitriol) as the vitamin D analogue. The study group comprised two haemodialysis patients who needed parathyroidectomy for uncontrolled 2HPT with a maximal PTG diameter >20 mm. The treatment began with an ultrasonographically guided injection of 10 µg of maxacalcitol solution into the largest PTG and, 1 week later, parathyroidectomy was performed to examine the effect of the maxacalcitol injection both macroscopically and microscopically. The injected glands were swollen and inflamed, and adhesions made it difficult to remove them. There was macroscopic and microscopic evidence of haemorrhagic necrosis and adhesions to the surrounding tissue. Direct vitamin D analogue injection should not be performed as a primary treatment option because the adverse side effects are not overcome by this technique.

Keywords: chronic renal failure; haemorrhagic necrosis; hyperparathyroidism; maxacalcitol; parathyroid gland

Correspondence and offprint requests to: Hiroyasu Yamamoto, Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo, 105-8461, Japan. Email: h-yamamoto{at}jikei.ac.jp


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