HYPERPARATHYROIDISM IN CONNECTION TO RENAL BONE DISEASE

Hi there,

I have secondary hyperparathyroidism due to RENAL bone disease. The pathology test for: 25 HYDROXY VITAMIN D,  reported a good reading,however the PTH test is elevated outside the range-5 times, why would a kidney specialist want to consider Vitamin D therapy, Rocaltrol(calcitriol), the drug used here in Australia? What I am really concerned about is that Vitamin D therapy has the potential to elevate the creatinine levels and  can it not jeopordise my ceatinine levels which ARE elevated , nevertheless stable,to a level where it is TOO HIGH and then cause a situation where I would PREMATURELY have to commence Dialysis???. The whole objective is to defer Dialysis, and be treated conservatively.  The PTH which was outside the range two-fold, 9 months ago,  was not brought to my attention, nor did the specialist make mention of Vitamin D therapy, when at that time, the creatinine level was lower.Also,because there  is a direct correlation between Calcium and the Parathyroid Hormone,(also bearing in mind that the pathology referral paper was marked URGENT),the pathology test was conducted and collected at the SAME TIME, however, the calcium test was reported 3 hours after collection, BUT the plasma parathyroid test was ONLY reported 3 DAYS later. Is there a possibility that because the 2 tests were reported on different days, that perhaps the reading is WRONG, and it would be worthwhile to REPEAT the test and stress to the lab. that the tests(both calcium and plasma parathyroid hormone)be reported TOGETHER?

Thanks
KATDEN

[Mark Lupo, M.D.]

Regarding the last question - if the labs were perfomed on the same sample, it is okay that the assays were done a different times -- this is not unusual.

The kidney converts 25-OH-D to 1,25-(OH)2-D which is the more active form.  in patients with kidney disease the 25-D may be fine but the 1,25 is low and rocaltrol IS 1,25 D and can decrease the PTH rise associated with renal disease and in turn decrease bone loss.  It is important to watch creatinine and Calcium closely during this type of treatment.

[Cyndi1005]

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