Evaluation of the Parathyroid Gland using Ultrasound Elastography in Children with Mineral Bone Disorder Due to Chronic Kidney Disease

Abstract

Objective: Mineral bone disorders due to chronic kidney disease (CKD-MBD) in children occur as a result of decreased glomerular filtration rate and abnormalities in phosphorus, calcium, parathyroid hormone, and vitamin D metabolism rates. Increased parathormone synthesis may result in the development of adenomas in the parathyroid gland. The aim of this study was to evaluate parathyroid lesions in children with CKD-MBD using ultrasound (US) elastography. Materials and Methods: Fifteen patients with a diagnosis of CKD-MBD (average age, 15.5±2.4 years; seven girls) and 15 healthy children (average age, 13.8±2.5 years; six girls) were included in the study. The patients were evaluated clinically and in terms of laboratory findings (calcium, phosphorus, alkaline phosphatase, vitamin D, and parathormone levels), and all patients were evaluated using strain US elastography. The parathyroid strain ratio indices of the study group were compared with the thyroid strain ratio indices of the control group. Results: Among 11 patients with stage 5 CKD who underwent parathyroid US, nodules were observed in 8 patients, whereas parathyroid nodules were not observed in 3 patients with stage 3-4 CKD. The parathyroid lesions average strain ratio index (1.1±0.5) was significantly higher than that of the control group (0.46±0.16). Conclusion: The stiffness of parathyroid lesions in children with US elastography was evaluated for the first time in this study to the best of our knowledge, and it is believed that a high strain ratio index could be a useful indicator of the presence of adenomas. We propose that the findings be supported by future larger studies. © 2020 Turkish Society of Nephrology. All rights reserved.