Definition

See notes: - Hyperparathyroidism
Long-standing chronic renal failure who have resolution of renal disease
Usually patients who have persistent autonomous secretion of PTH after renal transplantation
Loss of response to serum Ca2+ levels leads to four-gland hyperplasia with autonomous activity
- Can see marked asymmetry in parathyroid gland size
Renal transplant recipients often have additional risk factors for the development of tertiary HPT
- Alterations in GFR
- Transplant-associated drugs (corticosteroids, cyclosporine and thiazide diuretics)

Implications

Surgical Subtotal Parathyroidectomy indicated if persistent hypercalcaemia after 12 months of observation
In addition, patients with secondary HPT who are being considered for renal transplantation should have serum calcium and PTH levels screened pre-op

Calcific uremic arteriolopathy - Vascular calcification, thrombosis, and skin necrosis
Rare but serious, seen mainly in ESRF pts
- Commonly who are on HD or who have recently received a kidney transplant
Not exclusive to patients with ESRD (Non-uraemic calciphylaxis)
- Seen in 1°HPT, breast cancer (treated with chemo), EtOH liver cirrhosis, cholangioca, Crohn’s, RA, and SLE
Chronic non-healing wounds and can be fatal
Clinical diagnosis
- Characteristic ischaemic skin lesions with areas of skin necrosis associated with severe pain
- Appears as violaceous, leathery lesions and can be extensive
- Confirm with skin biopsy
- Small arterial calcification and occlusion in the absence of vasculitis
- Bone scintigraphy may show increased tracer accumulation in the soft tissues
Treatment
- Results for calciphylaxis are variable, prevention is crucial
- Rigorous and continuous control of phosphate and calcium balance
- Necrotic skin areas may become infected, leading to sepsis
Overall, clinical prognosis poor
Urgent Subtotal Parathyroidectomy is usually recommended