[Early symptoms of hyperparathyroidism in nephropathies]

The development of an autonomous (tertiary) hyperparathyroidism in patients with renal diseases must clinically be taken into consideration, when by therapeutic measures the causes of a compensatory overfunction of the parathyroid glands were excluded, but the symptoms of a hyperparathyroidism continue or even increase. This is of special importance in the control of patients with renal grafts. The increase of the serum calcium on more than the normal value in simultaneously increased serum phosphate level and increased activity of the alkaline bone phosphatase in connection with demineralisation of the skeleton, osteoclastic changes of the bones and estraossary calcifications may be regarded as early symptoms of a hyperparathyroidism. It is to be discussed the hypothesis, whether in every autonomous hyperparathyroidism a regulative reaction precedes. In patients with renal diseases in a limited number a prevention of the regulative overfunction of the parathyroid glands is possible by an early compensation of a calcium deficit (acquired vitamin D resistance), a hyperphosphataemia and a renal acidosis.