Secondary hyperparathyroidism, calcium disorders, and brown tumors after renal replacement therapy

An extreme case of secondary hyperparathyroisism in a 35-year-old male pati ent after renal transplantation is shown with development of a brown tumor in the left os ileum. After parathyroidectomy it came to a regression and a calcification of the brown tumor. Although in the last decades great progr ess has been made concerning renal transplantation therapy, secondary hyper parathyroidism (sHPT) is still of major clinical importance in patients wit h chronic renal failure and even in transplanted patients, especially in th e first year follow-up post transplantation. sHPT demineralizes bone struct ure via enhanced osteoclastic activity and can lead to osteofibrosis and in severe forms to brown tumor manifestations. On the other hand, defective k idneys are not able to synthesize sufficiently active vitamin D3 metabolite s. This can result in osteoidosis and various forms of osteomalacia. Recent ly, a change in the wide spectrum of renal osteodystrophy in forms of adyna mic bone disease and low turnover lesions is frequently observed. However, changes of parathyroid gland function in sHPT in renal insufficiency or in renal allograft recipients followed by adynamic bone disease indicate the c entral role in avoiding bone disease in these patients.