Renal hyperparathyroidism: Current therapeutic approaches and future directions

Today, surgical approach to secondary hyperparathyroidism (SHPT) remains an option for a limited number of patients. New pharmaceutical agents, as well as better prevention and earlier qualification for kidney transplantation, have significantly reduced candidates for secondary or renal HPT. Localization studies and parathyroid hormone assays have not clearly modified the conventional surgical approach of the disease. Controversy regarding the surgery to be favored, between subtotal parathyroidectomy and total parathyroidectomy with autotransplantation, continues against the background of relevant recurrence rates, persistent SHPT, and markedly increased complication rates in reoperation.