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September 1979

Renal Osteodystrophy

Author Affiliations

Department of Pediatrics State University of New York Upstate Medical Center 750 E Adams St Syracuse, NY 13210

Am J Dis Child. 1979;133(9):891-893. doi:10.1001/archpedi.1979.02130090019002

In this issue of the Journal (p 901), Talwalkar and his colleagues describe two young children with renal osteodystrophy resistant to phosphate restriction, calcium supplementation, and vitamin D therapy. After parathyroidectomy and partial autotransplantation, bone lesions healed promptly. After 20 months, roentgenograms and the serum immunoreactive parathyroid hormone (iPTH) level were normal. Three points of general interest derive from this article: (1) Medical management of renal osteodystrophy is sometimes unsatisfactory. (2) Partial parathyroidectomy may have gratifying clinical and biochemical results. (3) Autotransplantation, with convenient relocation of parathyroid remnants, facilitates evaluation of function and, if necessary, reoperation. The latter two points have been extensively discussed,1.2 and consensus favors the procedure so successfully used for the first time in children by Talwalkar's group. Pediatricians, however, will continue to be more concerned with the indications for parathyroid ablation than with the choice of procedure. The reasons for the occasional failure of

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