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What is Secondary Renal Hyperparathyroidism?

Secondary renal hyperparathyroidism is a disease involving both the endocrine system and skeletal system.  In this disorder, the blood calcium level of the turtle is out of ratio with the phosphorus.  This is caused by overactivity of certain glands caused by poor nutrition, environmental factors, and other underlying diseases.  Since the blood calcium level is too low, the body tries to find it where it can; in this case, it takes it from the bone itself.  As the body takes calcium from the bones to disperse elsewhere, it leads to malformations and deformities within the skeletal structure and shell.  It can also lead to calcification of soft tissues due to improper placement of the calcium by the body.  Symptoms can start out vague, such as weakness and lethargy, but once progressed can become more definitive, such as defective bone formation and renal damage.  Blood tests will need to be performed and a possible renal biopsy may need to be taken in order for the veterinarian to give a 100% diagnosis.  Treatment starts with getting the calcium phosphorous ratio back to normal and then additional supportive therapies are administered as needed.  If caught early and treated effectively, your turtle should be able to live a long, full life.

Secondary renal hyperparathyroidism is a degenerative bone disease that can affect your turtle.  It can cause lifelong deformities and may lead to his eventual death if not treated.

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Symptoms of Secondary Renal Hyperparathyroidism in Turtles

  • Defective bone formation 
  • Bone softening 
  • Weakness 
  • Lethargy 
  • Unable to lift and support body off the ground 
  • Pathological fractures
  • Renal damage 

Types

Secondary renal hyperparathyroidism in turtles is typically associated with soft tissue calcification, hyperphosphatemia, hypocalcemia, and osteodystrophy.  Or, more simply put, it is commonly known as a metabolic bone disease.  Secondary nutritional hyperparathyroidism is a similar condition to the renal version and both are sometimes used interchangeably when discussing the condition. 

Causes of Secondary Renal Hyperparathyroidism in Turtles

This condition is caused by the overactivity of these glands leading to osteitis fibrosa cystic and other bone related changes.  This can also be caused by nutritional deficits and would be a secondary result of the improper diet.  For example, a decrease in blood calcium concentrations can lead to this condition.

Diagnosis of Secondary Renal Hyperparathyroidism in Turtles

In order to properly diagnose secondary renal hyperparathyroidism, your veterinarian will want to run a series of diagnostic tests.  First, she will start by performing a physical exam and collecting a history from you.  This will allow her to take a proper look at your turtle and also get a better idea of what symptoms your turtle has developed, for how long, and if they have progressed in severity.  

Next, she will want to collect some blood and plasma for testing.  She will likely perform a complete blood count (CBC) and chemistry panel to see where his internal organ levels stand and if they are abnormal.  The renal level will likely appear abnormal and may lead her to want to check for reduced renal function by performing an iohexol clearance test.  Also, a radiograph will display any calcification or abnormalities of the internal organs.

Further diagnostics may be needed for a definitive diagnosis and will include a renal pathology, also known as a renal biopsy. 

Treatment of Secondary Renal Hyperparathyroidism in Turtles

The goal of treatment is to re-establish the proper calcium phosphorus ratio in the body.  In order to get to the proper level, your turtle may need oral administration of vitamin D or calcitonin salmon.  This is the main form of treatment your veterinarian will be able to offer your turtle. 

Ensuring you start feeding your turtle a proper diet is extremely important.  The veterinarian can give you suggestions based on his condition and his lab work results.  Any other symptoms your turtle is experiencing can be treated symptomatically as they appear.  If your turtle goes into renal failure, there is little you can do except attempt to prevent it from worsening or at least slow down the progression.

Recovery of Secondary Renal Hyperparathyroidism in Turtles

If diagnosed and treated in a timely manner, prognosis of recovery is good.  However, if you let the problem go on for an extended period of time, your turtle may be permanently disfigured due to the lack of calcium in the bloodstream.  If your turtle is diagnosed with secondary renal hyperparathyroidism, it is something you will need to monitor long term to ensure is does not reoccur or progress.