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



(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.



• 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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