PTH in CKD - STATE OF UNCERTAINTY OF PTH MEASUREMENT IN CKD...

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STATE OF ‘UNCERTAINTY’ OF PTH MEASUREMENT IN CKD Jun-Ki Park 12/14/10
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K/DOQI Guidelines
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PTH 1-84 PTH 7-84 PTH
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Different PTH assays and what they measure - First Generation PTH Assay ± Radioimmunoassays ± Polyclonal Ab’s directed toward synthetic C-terminal (such as 53-84 PTH) or mid-region (such as 44-68 PTH) PTH fragments. ± In addition to PTH 1-84, biologically inactive fragments are measured, which have a longer half-life than 1-84 PTH, and accumulate in CKD patients. ± Consequence: PTH concentrations were always increased. ± Currently considered obsolete for clinical practice.
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Second Generation PTH Assay ± First 2 nd -gen. PTH assay: ‘Allegro’ intact PTH assay: ± 2 different Ab’s: - Capture Ab : towards 39-84 portion of the PTH - 125-I-labeled Ab : towards 15-20 portion. (Thus unable to measure the C-terminal or mid-fragments, such as 53-84 or 44-68). ± Fully automated immunoanalyzers allowed better analytical performances and shorter turnaround time. ± ‘Allgro’ 15-20 portion; Elecsys/modular 26-32 portion. ± Globally called ‘intact’ PTH assays as they were thought to measure only the full-length 1-84 PTH.
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Second Generation PTH Assay ± More clinically satisfying data than 1 st gen. PTH assays (better correlation with bone biopsy parameters in CKD pts; clearly low values in ‘non-parathyroid’ hypercalcemia or hypoparathyroidism) However: ± Possibly overestimate degree of secondary HPT in CKD pts (Quarles et al. JCEM 1992; Wang et al. AJKD 1995) ± Leading to increased effort to suppress PTH ± Concern for the development of adynamic bone dz and erroneous referrals for parathyroidectomy.
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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PTH in CKD - STATE OF UNCERTAINTY OF PTH MEASUREMENT IN CKD...

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