血液透析患者の異所性石灰化に対して上皮小体摘出術をおこなった2症例

Abstract

Total parathyroidectomy and autotransplantation of the parathyroid tissue were performed on two male patients who had been on maintenance hemodialysis for metastatic calcification. A 33-year-old man and 43-year-old man, who had been on maintenance hemodialysis for 3 and 5 years, respectively, began to have pain in various joints. Their serum calcium level was normal, but their serum phosphate level was high; the calcium X phosphate product often exceeded 70. Their PTH level had increased, but their serum alkaline phosphatase level had not increased very much. X-rays of their bones showed no apparent signs of renal osteodystrophy. To relieve them of the pain in their joints, they were given lα-OH-D3 but metastatic calcification developed rapidly around many of their joints, thus impairing their motions. Total parathyroidectomy and autotransplantation of parathyroid tissue were performed to control the serum calcium and phosphate levels. After removal of the hyperfunctioning parathyroid glands, their serum phosphate level dropped, the calcium×phosphate product fell below 70, and the metastatic calcification disappeared rapidly. Parathyroidectomy was very effective in treating the metastatic calcification in patients who had chronic renal failure, because the metastatic calcification had developed secondarily to hyperparathyroidism.