RESUMO
BACKGROUND: The treatment of posttransplant secondary hyperparathyroidism (SHP) with vitamin D analogues is determined by their effectiveness to reverse hypercalcemia. Calcimimetics inhibit parathyroid hormone (PTH) secretion by modulating the calcium-sensing receptor in the parathyroid gland. Cinacalcet, a calcimimetic drug, has proven its effectiveness for the treatment of SHP among patients in phase V of chronic renal disease. PATIENTS AND METHODS: This retrospective analysis included 48 patients with SHP who were treated with cinacalcet. The initial dose of 30 mg/d could be increased to 180 mg, administering calcitriol also, depending on the serum calcium and PTH levels. The objectives were a PTH level between 75 and 125 pg/mL or a decrease >40%, and a serum calcium level below 10.5 mg/dL. RESULTS: The average PTH at baseline was 244 pg/mL, decreasing to 131 pg/mL at 1 year (P < .01). The average calcium at baseline was 10.1 mg/dL descending to 9.2 mg/dL at 1 year (P < .01). Among patients with hypercalcemia, the calcium decreased from 11 to 9.6 mg/dL at 1 year (P < .01). Seventy percent of patients without hypercalcemia reached the desired value of PTH, and 100% of those with hypercalcemia. Among patients with hypercalcemia, the desired calcium level was reached in 91% of cases. Ten patients developed hypocalcemia. In 3 cases we stopped the treatment with cinacalcet due to digestive intolerance. CONCLUSIONS: Treatment with cinacalcet controlled hyperparathyroidism and hypercalcemia among patients with posttransplant SHP. It was a safe drug, with a low incidence of side effects.
Assuntos
Hiperparatireoidismo Secundário/tratamento farmacológico , Transplante de Rim/efeitos adversos , Naftalenos/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Adolescente , Adulto , Idoso , Calcitriol/uso terapêutico , Cinacalcete , Feminino , Humanos , Hipercalcemia/sangue , Hipercalcemia/etiologia , Hiperparatireoidismo Secundário/sangue , Hiperparatireoidismo Secundário/etiologia , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Masculino , Pessoa de Meia-Idade , Fósforo/sangue , Estudos Retrospectivos , Vitamina D/análogos & derivados , Vitamina D/uso terapêutico , Adulto JovemRESUMO
We report a case of rectorrhage due to an hematoma of sigmoid colon post ESWL in a patient with chronic hepatopathy and right ureteral calculus. We comment the clinic and endoscopical study, as well as the review of literature.
