Characteristics of Parathyroid Ultrasound in Chronic Kidney Disease Patients Undergoing Hemodialysis
Main
Muhammad Yunus Rosyidi*
Widiana Ferriastuti
Widodo
Research on parathyroid ultrasound in kidney failure patients is highly relevant for understanding the relationship between parathyroid hormone levels and clinical conditions, optimizing therapeutic management for CKD patients. This study employs a quantitative observational descriptive design with cross-sectional approach to provide comprehensive overview of parathyroid ultrasound characteristics in CKD patients. Data were obtained from secondary medical records and parathyroid ultrasound examinations of CKD patients undergoing hemodialysis. This research shows that majority of chronic kidney disease (CKD) patients undergoing hemodialysis at Dr. Soetomo Regional Hospital in Surabaya have elevated serum iPTH and phosphate levels, while calcium levels are generally normal, though some patients experience hypocalcemia. Demographically, majority of patients are women (58%), aged 41–60 years, undergoing hemodialysis for 1–10 years. Parathyroid gland examination through ultrasound shows most patients have hypoechoic echogenicity, oval shape, well-defined borders, solid architecture, and size of 0.51–1 cm. More than half show no detectable vascularization, while some show perilesional blood flow patterns, serving as important indicators for detecting parathyroid hyperplasia. There is correlation between serum iPTH levels and morphological characteristics of parathyroid glands, including echogenicity, shape, size, and vascularization. At iPTH levels <500 pg/dL, parathyroid appears isoechoic to hypoechoic, oval, solid, measuring approximately 0.51–1 cm, with minimal vascularization. At 500–1000 pg/dL, perilesional vascularization begins appearing. When iPTH levels >1000 pg/dL, parathyroid enlarges (>1 cm), becomes hypoechoic in texture, and vascularization increases significantly, indicating more prominent morphological and vascular changes associated with increasing iPTH levels.
Arnold, A. (2017). Primary hyperparathyroidism: molecular genetic insights and clinical implications. Endocrine Abstracts. https://doi.org/10.1530/endoabs.50.PL1
Badan Penelitian dan Pengembangan Kesehatan Kementrian Kesehatan RI. (2013). Riset Kesehatan Dasar. Kementrian Kesehatan RI.
Centello, R., Sesti, F., Feola, T., Sada, V., Pandozzi, C., Di Serafino, M., Pacini, P., Cantisani, V., Giannetta, E., & Tarsitano, M. G. (2023). The Dark Side of Ultrasound Imaging in Parathyroid Disease. Journal of Clinical Medicine, 12(7), 2487. https://doi.org/10.3390/jcm12072487
Cunningham, J., Locatelli, F., & Rodriguez, M. (2011). Secondary Hyperparathyroidism. Clinical Journal of the American Society of Nephrology, 6(4), 913–921. https://doi.org/10.2215/CJN.06040710
Fang, L., Tang, B., Hou, D., Meng, M., Xiong, M., & Yang, J. (2015). Relationship between parathyroid mass and parathyroid hormone level in hemodialysis patients with secondary hyperparathyroidism. BMC Nephrology, 16(1), 82. https://doi.org/10.1186/s12882-015-0077-6
Galassi, A., Ciceri, P., Fasulo, E., Carugo, S., Cianciolo, G., & Cozzolino, M. (2019). Management of Secondary Hyperparathyroidism in Chronic Kidney Disease: A Focus on the Elderly. Drugs & Aging, 36(10), 885–895. https://doi.org/10.1007/s40266-019-00696-3
Geddes, R. F., Finch, N. C., Syme, H. M., & Elliott, J. (2013). The role of phosphorus in the pathophysiology of chronic kidney disease. Journal of Veterinary Emergency and Critical Care, 23(2), 122–133. https://doi.org/10.1111/vec.12032
Goodman, W. G. (2005). Calcium and Phosphorus Metabolism in Patients Who Have Chronic Kidney Disease. Medical Clinics of North America, 89(3), 631–647. https://doi.org/10.1016/j.mcna.2004.12.005
Herring, W. (2020). Learning Radiology: Recognizing the Basics. Elsevier.
Hou, Y., Lu, C., & Lu, K. (2018). Mineral bone disorders in chronic kidney disease. Nephrology, 23(S4), 88–94. https://doi.org/10.1111/nep.13457
IHME. (2013). The Global Burden of Disease: Generating Evidence, Guiding Policy. Institute for Health Metrics and Evaluation.
Kunstman, J. W., Kirsch, J. D., Mahajan, A., & Udelsman, R. (2013). Parathyroid Localization and Implications for Clinical Management. The Journal of Clinical Endocrinology & Metabolism, 98(3), 902–912. https://doi.org/10.1210/jc.2012-3168
Lau, W. L., Obi, Y., & Kalantar-Zadeh, K. (2018). Parathyroidectomy in the Management of Secondary Hyperparathyroidism. Clinical Journal of the American Society of Nephrology, 13(6), 952–961. https://doi.org/10.2215/CJN.10390917
Łebkowska, U., Malyszko, J., & Myśliwiec, M. (2003). Thyroid function and morphology in kidney transplant recipients, hemodialyzed, and peritoneally dialyzed patients. Transplantation Proceedings, 35(8), 2945–2948. https://doi.org/10.1016/j.transproceed.2003.10.066
Liu, J., Zhan, W. W., Zhou, J. Q., & Zhou, W. (2020). Role of ultrasound in the differentiation of parathyroid carcinoma and benign parathyroid lesions. Clinical Radiology, 75(3), 179–184. https://doi.org/10.1016/j.crad.2019.10.004
Mohammadi, A., Moloudi, F., & Ghasemi-rad, M. (2012). The role of colour Doppler ultrasonography in the preoperative localization of parathyroid adenomas. Endocrine Journal, 59(5), 375–382. https://doi.org/10.1507/endocrj.EJ11-0351
Morris, M. A., Saboury, B., Ahlman, M., Malayeri, A. A., Jones, E. C., Chen, C. C., & Millo, C. (2022). Parathyroid Imaging: Past, Present, and Future. Frontiers in Endocrinology, 12. https://doi.org/10.3389/fendo.2021.760419
Muppidi, V., Meegada, S. R., & Rehman, A. (2023). Secondary Hyperparathyroidism. StatPearls Publishing.
Nistala, R., & Savin, V. (2017). Diabetes, hypertension, and chronic kidney disease progression: role of DPP4. American Journal of Physiology-Renal Physiology, 312(4), F661–F670. https://doi.org/10.1152/ajprenal.00316.2016
Nolan, C. R., & Qunibi, W. Y. (2005). Treatment of hyperphosphatemia in patients with chronic kidney disease on maintenance hemodialysis. Kidney International, 67, S13–S20. https://doi.org/10.1111/j.1523-1755.2005.09502.x
Nowak, K. L., & Chonchol, M. (2020). Management of Mineral and Bone Disorders in Chronic Kidney Disease. In Chronic Renal Disease (pp. 1013–1033). Elsevier. https://doi.org/10.1016/B978-0-12-815876-0.00062-0
Okuno, S., Ishimura, E., Kitatani, K., Chou, H., Nagasue, K., Maekawa, K., Izumotani, T., Yamakawa, T., Imanishi, Y., Shoji, T., Inaba, M., & Nishizawa, Y. (2003). Relationship between parathyroid gland size and responsiveness to maxacalcitol therapy in patients with secondary hyperparathyroidism. Nephrology Dialysis Transplantation, 18(12), 2613–2621. https://doi.org/10.1093/ndt/gfg451
Onoda, N. (2003). Evaluation of blood supply to the parathyroid glands in secondary hyperparathyroidism compared with histopathology. Nephrology Dialysis Transplantation, 18(90003), 34iii – 37. https://doi.org/10.1093/ndt/gfg1009
Ozcan, U. A., & Oktay, I. (2009). Assessment of parathyroid glands in hemodialysis patients by using color Doppler sonography. European Radiology, 19(11), 2750–2755. https://doi.org/10.1007/s00330-009-1462-y
Pavlovic, D., & Tomic Brzac, H. (2006). Ultrasonographic Evaluation of Parathyroid Hyperplasia in Dialysis Patients. The Scientific World JOURNAL, 6, 1599–1608. https://doi.org/10.1100/tsw.2006.273
Prince, S. A., & Wilson, L. M. (2005). Patofisiologi Konsep Klinis Proses-Proses Penyakit. EGC.
Ribeiro, C., Penido, M. G. M. G., Guimarães, M. M. M., Tavares, M. de S., Souza, B. das N., Leite, A. F., Deus, L. M. C. de, & Machado, L. J. de C. (2016). Parathyroid ultrasonography and bone metabolic profile of patients on dialysis with hyperparathyroidism. World Journal of Nephrology, 5(5), 437. https://doi.org/10.5527/wjn.v5.i5.437
Sezai, A., Nakata, K., Hata, M., Yoshitake, I., Wakui, S., Hata, H., & Shiono, M. (2013). Long-Term Results of Dialysis Patients with Chronic Kidney Disease Undergoing Coronary Artery Bypass Grafting. Annals of Thoracic and Cardiovascular Surgery, 19(6), 441–448. https://doi.org/10.5761/atcs.oa.12.02028
Taniguchi, M., Tokumoto, M., Tsuruya, K., Hirakata, H., & Iida, M. (2008). Intravenous calcitriol therapy in an early stage prevents parathyroid gland growth. Nephrology Dialysis Transplantation, 23(11), 3662–3669. https://doi.org/10.1093/ndt/gfn264
Thomas, R., Kanso, A., & Sedor, J. R. (2008). Chronic Kidney Disease and Its Complications. Primary Care: Clinics in Office Practice, 35(2), 329–344. https://doi.org/10.1016/j.pop.2008.01.008
Tominaga, Y., Tanaka, Y., Sato, K., Nagasaka, T., & Takagi, H. (1997). Histopathology, pathophysiology, and indications for surgical treatment of renal hyperparathyroidism. Seminars in Surgical Oncology, 13(2), 78–86. https://doi.org/10.1002/(SICI)1098-2388(199703/04)13:2<78::AID-SSU3>3.0.CO;2-Z
Vulpio, C., Bossola, M., De Gaetano, A., Maresca, G., Di Stasio, E., Zagaria, L., Luciani, G., Giordano, A., & Castagneto, M. (2010). Parathyroid Gland Ultrasound Patterns and Biochemical Findings After One‐year Cinacalcet Treatment for Advanced Secondary Hyperparathyroidism. Therapeutic Apheresis and Dialysis, 14(2), 178–185. https://doi.org/10.1111/j.1744-9987.2009.00781.x
