Renal Osteodystrophy due to Secondary Hyperparathyroidism in a Cat

A 6 yr old neutered male mixed-breed cat presented for renal transplantation (RTx) for chronic kidney disease. Severe periodontal disease was identified, and before initiation of immunosuppressive therapy, a comprehensive oral health assessment and treatment procedure was performed to reduce the burden of existing oral infection. Dental radiography revealed diffuse, severe bone demineralization across the mandible and maxilla, with thinning of the cortices. Nasal turbinates were easily visualized owing to the decreased opacity of maxillary bone. Generalized bone resorption left teeth to appear minimally attached. A Vitamin D panel revealed a severely elevated parathyroid hormone level. Full mouth extractions were performed. Seven days following this procedure, RTx was performed. Serum creatinine concentration was within normal limits by 48 hr after surgery and remained normal until discharge 12 days after RTx. At 3.5 mo after RTx, the cat was mildly azotemic, and the parathyroid hormone level was elevated but significantly decreased from the original measurement. Secondary hyperparathyroidism is a common abnormality in cats with chronic kidney disease. However, clinical manifestations of hyperparathyroidism are rare in this species. This is a novel presentation of a cat demonstrating bone loss in the oral cavity as a result of renal secondary hyperparathyroidism.

ASSESSMENT OF INTRA OPERATIVE PARATHYROID HORMONE LEVEL: AS AN INDICATOR FOR POST-OPERTIVE CALCIUM THERAPY IN A PATIENT UNDERGOING NEAR TOTALAND TOTAL THYROIDECTOMY

Thyroid and parathyroid are anatomically close to each other. Blood supply to parathyroid may get cut off inadvertently or all parathyroid tissue may get removed removed during near total or total thyroidectomy.As a result of near total and total thyroidectomy it may lead to hypocalcemia crisis post-operatively causing tingling, numbness, tetany, neuro-muscular dysfunction.Hypocalcemia is the most common etiological factor for prolonged hospitalization in patients undergoing total thyroidectomy.Recent studies concludes that, hypocalcemia can be prevented by assessing S. PTH levels pre-operatively and intra-operatively one hour after removing the gland.This study includes 30 patients, who underwent near total and total thyroidectomy from August 2018-July2020 with thyroid swelling where indicated for surgery.Patients who underwent total thyroidectomy for malignancy (10 out of 30) developed hypocalcemia, this attributed to the extensive surgical dissection performed in malignant disorders in order to obtain tumour clearance.For the Stratication of thyroidectomy patients who may develop hypocalcemia into low and high risk category, a single 1-hour post-thyroidectomy PTH level is very useful.

Paget´s disease of bone in a patient on peritoneal dialysis

Paget´s disease of bone is a disorder characterized by disorganized bone remodeling. It´s occurrence in patients with end-stage kidney disease on renal replacement therapy is rare. Here we report a case of Paget´s disease of bone in an 80-year-old male on peritoneal dialysis that presented a high level of alkaline-phosphatase with a mildly elevated parathyroid hormone level and typical imaging findings localized to the pelvis. This is the fourth reported case of Paget´s disease in a patient on peritoneal dialysis and the first treated with denosumab.