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ISN Education: Ask the Experts

  1. Dimitra Bacharaki
  2. Chronic Kidney Disease
  3. Wednesday, June 29 2016, 04:23 AM
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In what level of GFR would it be expected to have a rise in PTH? For example in a 57 year old woman, 180cm tall, 75kg, MDRD 36 ml/min, Cockrauft Gault 48 ml/min, PTH 99 pg/mL (reference 10-65), 25OHD3 levels 35 ng/ml. DEXA scan osteopenia. Would it be justified a SESTAMIBI scan for parathyroid adenoma?
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i expect the pth well start rising once the gfr drop below 60ml/min
i wouldnt justify doing isotope scan fpr pth
since it is expected to rise to this level at this stage
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  2. 5 months ago
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Tejas Desai Accepted Answer
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Dear Dimitra, Many thanks for your question. You can see how our twitter community of nephrologists have responded to your question below:

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  1. https://twitter.com/ISNkidneycare/status/748088006993649664
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  1. more than a month ago
  2. Chronic Kidney Disease
  3. # 1
Masafumi Fukagawa Accepted Answer
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According to CRIC study (Isakova T et al. Kidney Int, 2011) and OVIDS-CKD study (Nakano C et al. Clin J Am Soc Nephrol, 2012) , slight increase of PTH at this level of eGFR seems to be possible.
Enlargement of parathyroid glands are seldom detectable at this stage, except for CKD patients accompanied with primary hyperparathyroidism. Such patients often have single adenoma.
In either situation, I recommend ultrasonography for the initial evaluation rather than SESTAMIBI.
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  1. more than a month ago
  2. Chronic Kidney Disease
  3. # 2
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