الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Kidney damage that lasts for at least three months, as determined by kidney structural or functional abnormalities, together with or without a reduced glomerular filtration rate (GFR) or a GFR less than 60 mL/min/1.73m2 for at least three months, may or may not be indicative of chronic kidney disease (CKD).
Renal hyperparathyroidism (rHPT) is a prevalent consequence of chronic kidney disease (CKD) that manifests as disruptions in the calcium, phosphorus, and vitamin D balance. The American health care system bears a heavy financial cost due to the increased cardiovascular morbidity and death linked to rHPT.
Traditionally, a patient’s blood calcium level has been used to categorize rHPT into two kinds. An increase in parathyroid hormone (PTH) in reaction to hypocalcaemia caused by phosphate retention and decreased calcitriol production due to impaired renal function is known as secondary hyperparathyroidism (2° HPT). In 2° HPT, parathyroid hyperplasia causes enlargement of all parathyroid glands. Since 2° HPT is a parathyroid gland compensatory mechanism, it usually goes away once the calcium and phosphorus levels are back to normal (for example, after a kidney transplant). When a patient with chronic 2° HPT begins to secrete PTH on their own, typically in conjunction with hypercalcaemia, this is known as tertiary hyperparathyroidism (3° HPT). Up to 30% of individuals with end-stage renal disease (ESRD) who subsequently have a kidney transplant experience this. Contrary to popular belief, up to 20% of individuals may really have one or two adenomas, even though 3° HPT is often associated with parathyroid hyperplasia.
Although the use of calcimimetic drugs, phosphate binders, vitamin D analogs, and phosphate binders to improve medical management has increased the treatment options for patients with rHPT, parathyroidectomy remains essential for many.
Requirements for parathyroidectomy in patients with renal hyperparathyroidism:
• Medical management of a prolonged hypocalcaemia and hyperphosphatemia (HPT) exceeding six months.
PTH concentrations exceed 800 pg/ml.
• Progressive calcifications or calciphylaxis of the extra-skeletal system accompanied by elevated PTH levels and refractory hyperphosphatemia.
Pathological bone fractures and osteoporosis (T-score >2.5 SD below mean) are both considered.
Our most important findings:
The mean age of the study group was 40.6 ± 12.1 years,26 (52%) were males,31 (62%), mean BMI was 21.8 ± 3.6kg/m² and regarding causes of dialysis, Obstructive uropathy represented 58% of the study group followed by Pyelonephritis 18%, Polycystic kidney 12% , Eclampsia 8%, lupus nephritis and Albert syndrome represented 2% each of them
There was no significant difference between the 4 groups in serum creatinine, Urea, ALT and AST, also there was no significant difference between groups regarding Hb, MCV, Platelets, WBCs and INR.
There was significant difference between groups as group III (phosphate binder recievers) and IV( 1alpha receivers) had lower total serum calcium other than group I and II, also group I had lower serum calcium in all measurements after Para thyroidectomy P value 0.0001 ,also group III has lower serum ionized calcium than the other groups which is significantly different in comparison with group I and II but not with group IV.
There was significant difference between groups as there was significant decrease in serum phosphorus in group IV(1 Alpha receivers ) after 1 month of treatment, and there was significant decrease in serum phosphorus after 2 months in group I (parathyroidectomy group) and group IV( 1 Alpha receivers), also there was significant decrease in serum phosphorus in 3rd &4th months in group I(parathyroidectomy )and group IV(1Alpha receivers). Also there was significant difference regarding serum magnesium between groups as group I (parathyroidectomy) and group III (phosphate binder) had significant decrease.
Also there was significant decrease in serum parathormone level in group I in comparison with other groups in all serial measurements as intial level of parathormone was 1755.0 (1498 – 2450), 1225.0 (862.5 – 2171.3), 820.0 (732 – 1567.5), 813.5(738.8 – 1029.8) in goup I, II, III and IV respectively, Also there was significant decrease in serum parathormone in all groups in serial measurements. And there was no significant difference in serum levels of vit D in comparison between all groups.