Secondary hyperparathyroidism - an updated view of pathogenic and clinical aspects

Secondary hyperparathyroidism occurs early in the course of chronic renal failure. The most important factors at this stage are deficit of calcitriol and abnormalities in the calcium sensor and calcitriol receptors. As renal failure advances, hyperphosphatemia turns into an additional important pathogenic factor. Reducing hyperphosphatemia is essential and the first step in the management of secondary hyperparathyroidism. Moreover, the persistent hyperphosphatemia has been associated with metastatic calcifications and calciphylaxis. Poor control of hyperphosphatemia aggravates the hyperparathyroidism and bone disease, increasing morbidity and mortality risk. The present review describes recent advances regarding the pathogenic aspects of secondary hyperparathyroidism as well as discusses new therapeutic approaches. 8-1413hiper.p65 26/04/02, 11:19 48 Hiperparatiroidismo secundario – Mendonca DU et al. J Bras Nefrol 2002;24(1):48-55 49 ! #$ % & ' ( ) !* + . / 0 . * 1/ ' + 2 * % 1 / 0 3 / ' + 4 ) ' & * ) / % 1 ' ) ! + 4 % 1 6