Accelerated progression of chronic renal insufficiency after parathyroidectomy

Three patients with chronic renal failure developed secondary hyperparathyroidism, complicated by severe bone disease in two patients and by acral skin necrosis in the third. Following subtotal parathyroidectomy, the bone disease and the necrotic lesions rapidly improved, but the rate of loss of renal function accelerated concomitant with administration of calcium and vitamin D, although no hypercalcemia developed. Avoiding postoperative administration of calcium and/or vitamin D, unless indicated for symptomatic hypocalcemia, may prevent accelerated loss of renal function in patients requiring subtotal parathyroidectomy.