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Does Sensipar Interact With Renagel?
Question: My father has hypertension and Kidney Disease and is on dialysis 3.5hrs 3x weekly. For the past 6 months, his PTH has skyrocketed, almost to 1200. He is on Renagel 800mg 3x daily and the doctor added Sensipar 60mg daily as well, however the number has not gone down. What's weird is his calcium, magnesium and albumin levels are all normal and always have been. What could this be and how could this be treated?
Brief Answer:
Tertiary hyperparathyroidism
Detailed Answer:
Good day.
Noted the question. It appears that he had secondary hyperparathyroidism secondary to kidney failure which has now progressed to tertiary hyperparathyroidism. You will have to test his phosphorus levels and keep them down. When the PTH levels are above 800 or if Patient develops severe itching, they may need surgery to remove parathyroid glands. It's best to consult an endocrinologist to discuss.
It's also good to test his Vitamin D levels and give him calcitriol.
Regards
Binu
Tertiary hyperparathyroidism
Detailed Answer:
Good day.
Noted the question. It appears that he had secondary hyperparathyroidism secondary to kidney failure which has now progressed to tertiary hyperparathyroidism. You will have to test his phosphorus levels and keep them down. When the PTH levels are above 800 or if Patient develops severe itching, they may need surgery to remove parathyroid glands. It's best to consult an endocrinologist to discuss.
It's also good to test his Vitamin D levels and give him calcitriol.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Prasad
Thank you. His last couple tests have come back with the Phosphorus mostly normal, sometimes high, but not always. Also, they started to test his Vitamin D levels and it is also normal. Does hyperathyrodism have any severe effects on the body or health?
Brief Answer:
Adverse effects on Bone and vascular system.
Detailed Answer:
Despite being on dialysis and on phosphorus lowering drugs, phosphorus can go high in kidney failure which is a stimulus for PTH to rise. Other stimuli to rise PTH are a) low cslcium b) low vitamin D, c) Excess Calcitriol (activated vitamin D) replacement.
This is called secondary hyperparathyroidism. However, after a while secondary hyperparathyroidism moves on to develop Tertiary Hyperparathyroidism where PTH continues to rise with our any stimuli. This is similar to primary hyperparathyroidism where the parathyroid glands start producing PTH excessively without an obvious cause.
Irrespective of the cause, hyperparathyroidism can cause weakness of the bones leading to Osteoporosis and fracture, High blood pressure and has other bad cardiovascular effects.
This needs to be tackled by an endocrinologist in association with Nephrologist. Often drugs fail to bring down PTH effectively at this stage and they would need surgery.
Regards
Binu
Adverse effects on Bone and vascular system.
Detailed Answer:
Despite being on dialysis and on phosphorus lowering drugs, phosphorus can go high in kidney failure which is a stimulus for PTH to rise. Other stimuli to rise PTH are a) low cslcium b) low vitamin D, c) Excess Calcitriol (activated vitamin D) replacement.
This is called secondary hyperparathyroidism. However, after a while secondary hyperparathyroidism moves on to develop Tertiary Hyperparathyroidism where PTH continues to rise with our any stimuli. This is similar to primary hyperparathyroidism where the parathyroid glands start producing PTH excessively without an obvious cause.
Irrespective of the cause, hyperparathyroidism can cause weakness of the bones leading to Osteoporosis and fracture, High blood pressure and has other bad cardiovascular effects.
This needs to be tackled by an endocrinologist in association with Nephrologist. Often drugs fail to bring down PTH effectively at this stage and they would need surgery.
Regards
Binu
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Yogesh D
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