[Parathyroidectomy in children with renal failure. Retrospective study of 17 cases]

Parathyroidectomy (PTX) is rarely needed in children with end-stage renal disease and the new forms of vitamin D decrease its frequency. We report 17 cases of patients (14 with dialysis and 3 with functional renal graft) suffering from renal insufficiency in the pediatric age group who required a PTX. The surgical indications and techniques (partial PTX, total PTX with or without graft) varied with time and circumstances. After partial PTX, 3/10 patients were reoperated on. After PTX + graft one patient needed a second graft and another a graft curettage. Whatever the method, we noted normalization of clinical and radiological signs and a decrease in biological signs. The growth rate improved in most children during puberty, but outside of this period, no effect was noted. There is a definite indication for a PTX in cases with tertiary hyperparathyroidism. The indication seems questionable in cases with secondary hyperparathyroidism which can now be effectively treated with 1 alpha-hydroxylated forms of vitamin D. When necessary, total PTX with or without graft should be performed.