What could be done for patients with chronic renal failure are marginally beneficial. Among 58 pre-dialysis patients, we found 24 of chronic glomerulonephritis (CGN) with serum creatinine >5 mg/dl and intact parathyroid hormone (i-PTH) >200 pg/ml. In this study, we determined if the residual renal function could be preserved when hyperparathyroidism was corrected by either low-dose calcitriol treatment or ethanol injection. The 58 CGN patients were divided into three groups. The first group, which comprised 11 cases with i-PTH >200 pg/ml and had parathyroid mass, were treated by ultrasonography-guided percutaneous ethanol injection therapy (PEIT). The second study group composed of 13 cases with i-PTH >200 pg/ml without parathyroid mass were treated by calcitriol 1 µg every other day. The third group made up of 34 cases with i-PTH <200 pg/ml, who did not receive calcitriol or ethanol therapy. All patients were followed up within 2 years or until dialysis. The average rate of decline in renal function (slope of reciprocal serum creatinine vs. time) was 0.0025 ± 0.0026 dl/mg month in group 1, 0.0054 ± 0.0024 in group 2, and 0.0067 ± 0.0025 in group 3 (p = 0.018 in group 1 vs. group 2, p < 0.001 in group 1 vs. group 3). The declines of i-PTH, phosphorus, and alkaline phosphatase, and the increase of calcium were all significantly different between group 1 and group 3. Two cases of group 1, 6 cases of group 2, and 20 cases of group 3 entered into dialysis during this study. In conclusion, selective PEIT guided by color Doppler flow mapping is an effective therapy for treating hyperparathyroidism and protecting the residual renal function.

Keywords:
Chronic renal failure, Secondary hyperparathyroidism, Renoprotection, Ethanol injection, Calcitriol therapy
1.
Mawer EB, Backhouse J, Taylor CM, Lumb GA, Stanbury SW: Failure of formation of 1,25-dihydroxy-cholecalciferol in chronic renal insufficiency. Lancet 1973;i:626–628.
2.
Portale AA, Booth BE, Halloran BP, Morris RC Jr: Effect of dietary phosphorus on circulating concentrations of 1,25-dihydroxyvitamin D and immunoreactive parathyroid hormone in children with moderate renal insufficiency. J Clin Invest 1984;73:1580–1589.
3.
Nordal KP, Dahl E: Low dose calcitriol versus placebo in patients with predialysis chronic renal failure. J Clin Endocrinol Metab 1988;67:929–936.
4.
Hutchison AJ, Whitehouse RW, Boulton HF, Adams JE, Mawer EB, Freemont TJ, Gokal R: Correlation of bone histology with parathyroid hormone, vitamin D3, and radiology in end-stage renal disease. Kidney Int 1993;44:1071–1079.
5.
Nordal KP, Dahl E, Halse J, Attramadal A, Flatmark A: Long-term low-dose calcitriol treatment in predialysis chronic renal failure: Can it prevent hyperparathyroid bone disease? Nephrol Dial Transplant 1995;10:203–206.
6.
Hamdy NAT, Kanis JA, Beneton MNC, Brown CB, Juttmann RJ, Jordans JGM, Josse S, Meyrier A, Lins RL, Fairey IT: Effect of alfacalcidol on natural course of renal bone disease in mild to moderate renal failure. Br Med J 1995;310:358–363.
7.
Panichi V, Andreini B, Depietro S, Migliori M, Taccola D, Giovannini L, Ferdeghini M, Palla R: Calcitriol oral therapy for the prevention of secondary hyperparathyroidism in patients with predialytic renal failure. Clin Nephrol 1998;49:245–250.
8.
Winterborn ME, Mace PJ, Heath DA, White RHR: Impairment of renal function in patients on 1α-hydroxycholecalciferol. Lancet 1978;ii:150–151.
9.
Healy M, Malluche HH, Goldstein DA, Singer FR, Massry SG: Effects of long-term therapy with 1,25(OH)2D3 in patients with moderate renal failure. Arch Intern Med 1980;140:1030–1033.
10.
Nielsen HE, Romer FK, Melsen F, Christensen MS, Hansen HE: 1α-Hydroxy vitamin D3 treatment of non-dialyzed patients with chronic renal failure. Effects on bone, mineral metabolism and kidney function. Clin Nephrol 1980;13:103–108.
11.
Solbiati L, Giangrande A, Pra LD, Belloti E, Cantu P, Ravetto C: Percutaneous ethanol injection of parathyroid tumor under ultrasound guidance: Treatment for secondary hyperparathyroidism. Radiology 1985;155:607–610.
12.
Reiss E, Canterbury JM, Edgahl RH: Experience with radioimmunoassay of parathyroid hormone in human sera. Trans Assoc Am Physns 1968;81:104.
13.
Arnaud C: Hyperparathyroidism and renal failure. Kidney Int 1973;4:89.
14.
Malluche H, Faugère M: Renal bone disease 1990: An unmet challenge for the nephrologist. Kidney Int 1990;38:193–211.
15.
Malluche H, Ritz E, Kutschera J, Krause K, Werner E, Gati A, Seiffert U, Lange H: Calcium metabolism and impaired mineralization in various stages of renal insufficiency; in Norman A, Scaeffer K, Grigoleit H, Herrath D, Ritz E (eds): Vitamin D and Problems Related to Uremic Bone Disease. Berlin, Walter de Gruyte, 1975, pp 513–522.
16.
Cundy T, Hand DJ, Oliver DO, Woods CG, Wright FW, Kanis JA: Who gets renal bone disease before beginning dialysis? Br Med J 1985;290:271–275.
17.
Goodman WG, Coburn JW: The use of 1,25-dihydroxyvitamin D3 in early renal failure. Annu Rev Med 1992;43:227–237.
18.
Bertoli M, Luisetto G, Ruffatti A, Urso M, Romagnoli G: Renal function during calcitriol therapy in chronic renal failure. Clin Nephrol 1990;33:98–102.
19.
Baker LRI, Abrams SML, Roe CJ, Faugère MC, Fanti P, Subayti Y, Malluche HH: 1,25(OH)2D3 administration in moderate renal failure. Kidney Int 1989;35:661–669.
20.
Coen G, Mazzaferro S, Manni M, Fondi G, Perruzza I, Pasquali M, Taggi F: No acceleration and possibly slower progression of renal failure during calcitriol treatment in predialysis chronic renal failure. Nephrol Dial Transplant 1994;9:1520.
21.
Cohen SM, Sebert J, Boudailliez B, Marie A, Morinière P, Guéris J, Bouillon R, Fournier A: Comparison of intact, midregion, and carboxy terminal assays of parathyroid hormone for the diagnosis of bone disease in hemodialyzed patients. J Clin Endocrinol Metab 1991;73:516–524.
22.
Adams J, Chen S, Adams P, Isherwood I: Measurement of trabecular bone mineral by dual energy computed tomography. J Comp Assist Tomogr 1982;6:601–607.
23.
Genant H, Block J, Steiger P, Glueer C, Ettinger B, Harris S: Appropriate use of bone densitometry. Radiology 1989;170:817–822.
24.
Quarles LD, Lobaugh B, Murphy G: Intact parathyroid hormone overestimates the presence and severity of parathyroid-mediated osseous abnormalities in uremia. J Clin endocrinol Meta 1992;75:145–150.
25.
Torres A, Lorenzo V, Hernandez D, Rodriguez JC, Concepcion MT, Rodriguez AP, Hernandez A, de Bonis E, Gonzalez-Posada JM, Losada M, Rufino M, Felsenfeld AJ, Rodriguez M: Bone disease in predialysis, hemodialysis, and CAPD patients: Evidence of a better bone response to PTH. Kidney Int 1995;47:1434–1442.
26.
Giangrande A, Castiglioni A, Solbiati L, Ballarati E, Caligara F: Chemical parathyroidectomy for recurrence of secondary hyperparathyroidism. Am J Kidney Dis 1994;24:421–426.
27.
Bennedbak FN, Karstrup S, Hegedus L: Percutaneous ethanol injection therapy in the treatment of thyroid and parathyroid disease. Eur J Endocrinol 1997;136:240–250.
28.
Kakuta T, Fukagawa M, Fujisaki T, Hida M, Suzuki H, Sakai H, Kurokawa K, Saito A: Prognosis of parathyroid function after successful percutaneous ethanol injection therapy guided by color Doppler flow mapping in chronic dialysis patients. Am J Kidney Dis 1999;33:1091–1099.
29.
Tominaga Y, Tanaka Y, Sato K, Nagasaka T, Takagi H: Histology, pathophysioloy, and indications for surgical treatment of renal hyperparathyroidism. Semin Surg Oncol 1997;13:78–86.
30.
Tominaga Y, Kohara S, Namii Y, Nagasaka T, Haba T, Uchida K, Numano M, Tanaka Y, Takagi H: Clonal analysis of nodular hyperplasia in renal hyperparathyroidism. World J Surg 1996;20:744–752.
31.
Arnold A, Brown MF, Urena P, Gaz RD, Sarfati E, Drueke TB: Monoclonality of parathyroid tumors in chronic renal failure and in primary parathyroid hyperplasia. J Clin Invest 1995;95:2047–2053.
32.
Fukuda N, Tanaka H, Tominaga Y, Fukagawa M, Kurokawa K, Seino Y: Decreased 1,25-dihydroxyvitamin D3 receptor density associated with a more severe form of parathyroid hyperplasia in chronic uremic patients. J Clin Invest 1993;92:1436–1443.
33.
Koike T, Fukuda N, Fukagawa M, Ohta K, Kurokawa K: Correlation of enhanced cell proliferation with decreased density of vitamin D receptor in situ in parathyroid hyperplasia in chronic dialysis patients. Nephrology 1997;3:279–284.
34.
Kifor O, Moore FD Jr, Wang P, Goldsten M, Vassilev P, Kifor I, Hebert SC, Brown EM: Reduced for the extracellular Ca-sensing receptor in primary and uremic secondary hyperparathyroidism. J Clin Endocrinol Metab 1996;81:1598–1606.
35.
Gogusev J, Duchambon P, Hory B, Giovanninni M, Goureau Y, Sarfati E, Drueke TB: Depressed expression of calcium receptor in parathyroid gland tissue of patients with hyperparathyroidism. Kidney Int 1997;51:328–336.
36.
Ibels LS, Alfrey AC, Haut L, Huffer WE: Prevention of function in experimental renal disease by dietary restriction of phosphate. N Engl J Med 1978;298:122–126.
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2002
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