Chronic renal failure: diagnostic measures before parathyroidectomy

To investigate whether conventional criteria suffice to differentiate between hyperparathyroid and aluminum (Al)-related bone disease, we obtained bone biopsies from 7 patients with chronic renal failure (CRF) at the time of PTX and 3.5-36 months later. All had hypercalcemia and elevated mid-region parathyroid hormone levels and 3 had bone pain at PTX. Bone histomorphometry revealed that 5 patients had hyperparathyroid bone disease at PTX, while 2 had osteomalacia and skeletal Al deposits. Retrospective determination of intact PTH showed normal levels at PTX in the latter two. PTX effectively reduced all indices of parathyroid hyperactivity, but the two patients with Al-related bone lesions did not improve clinically nor histologically after PTX. Intact PTH and/or bone biopsy prior to PTX could have deterred surgery in those with Al-related bone disease.