[Significance of point of no return in therapeutic strategy for treatment of renal osteodystrophy; from histopathological findings].

Point of no return implies a stage at irreversible to medical treatment of secondary hyperparathyroidism, clinically equivalent to intact PTH levels are more than 500 pg/mL in Japan. Most of glands resected by parathyroidectomy indicate nodular hyperplasia, increased parathyroid cell proliferation. Down-regulation of calcium sensing receptors and vitamin D receptors in nodular parathyroid cells become a cause of resistance to medical treatment. Most of nodular glands are more than 500 mg in weight, predictable to existence at estimated volume and gland color signals by ultrasonographic method. New options both parathyroid injection therapy using ethanol and active vitamin D, and calcimimetic agent have a potential to change point of no return in therapeutic strategy for secondary hyperparathyroidism.