Miles et al developed a simple algorithm for managing a patient with hyperparathyroidism following a renal transplant. The authors are from the State University of New York in Brooklyn.
Patient selection:
(1) >= 1 year after the renal transplant
(2) serum iPTH > 400 pg/mL
Parameters:
(1) serum calcium
(2) symptoms of hyperparathyroidism
Symptoms of hyperparathyroidism may include:
(1) pathologic fractures
(2) calciphylaxis
(3) nephrolithiasis
(4) gastrointestinal symptoms
Parathyroidectomy is done if:
(1) symptoms of hyperparathyroidism are severe
(2) serum calcium is > 12.5 mg/dL
If the criteria for parathyroidectomy are not met and the calcium is low or normal (< 10.5 mg/dL), then the patient receives conservative management which includes calcium and/or vitamin D supplements.
If the patient has an elevated calcium (>= 10.5 mg/dL) then bisphosphonates or 22-oxacalcitriol may be given and the patient observed.
where:
• Patient selection includes >= 1 year after transplant, yet the tree has a point for the patient being < 1 year after transplant under a serum calcium > 12.5 mg/dL.
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