Prevention and treatment of secondary hyperparathyroidism: still a challenge for the nephrologist?

Secondary hyperparathyroidism is a well known complication of chronic renal insufficency. It is not only a state of increased parathyroid hormone secre-tion but also a state of parathyroid gland hyperplasia. Prevention and treatment of secondary hyperpara-thyroidism is a huge challenge for the nephrologist, despite new agents for the treatment of hyperphos-phataemia, new vitamin D analogues and calci-mimetics. The importance of parathyroid gland hyperplasia and the possibility of its reduction frequently are neglected issues. Ultrasonography could be very useful in detection of parathyroid gland size and shape and in the management of secondary hyperparathyroidism.