Clinical Case

Scenario 2 – Part 2: Further laboratory investigations revealed normal thyroid and liver function tests, 25 (OH) vit D was 14 ng/mL. The patient underwent surgical decompression of the spinal cord and correction of the kyphosis according to the neurosurgeon’s recommendations. Denosumab 60 mg SC biyearly was started together with calcium and Vitamin D supplementation, […]

Scenario 2 – Part 1: A 38-year-old male with ESKD was referred to the neurosurgery clinic because of muscle weakness in both upper limbs and posterior neck pain. He had been undergoing peritoneal dialysis for five years. DEXA scan showed a T-score of −2.5 in left femoral head and −2.9 in lumbar spine. MRI scan […]

Scenario 1 – Part 2: The patient had been prescribed Vit D and phosphate supplements with a considerable improvement of his symptoms. One year earlier, the patient was seen at the gastroenterology clinic complaining of chronic diarrhea which has been attributed to the phosphate supplements after thorough investigations to exclude other causes. Unfortunately, CT abdomen […]

Scenario 1 – Part 1: A 24-year-old man was seen at the outpatient clinic because of persistent hypophosphatemia. The patient had been previously well until two years ago, when he developed a hip fracture upon falling downstairs. After which, he suffered generalised bony pains for the subsequent two years.  Laboratory investigations performed at time of […]

Scenario 3: A 62-year-old man, who has been on for 10 years, presents with gradually increasing bone pain. Current medications include alfacalcidol 1 mcg/day and calcium carbonate 1500 mg. The patient’s labs are shown in table 1 Test Value S. Creatinine 3.9 mg/dL S. corrected Calcium 10.5 mg/dL S. Phosphorus 7.1 mg/dL iPTH 18 pg/mL […]

Scenario 2 – Part 2: The above-mentioned bone biopsy study recruited another patient with ESKD who underwent parathyroidectomy 12 months ago with a similar preoperative clinical profile. However, he developed progressive cognitive dysfunction a few months post-parathyroidectomy. The bone histopathological pictures are presented in figure 2 &3. figure 2 figure 3 figure 3 is stained […]

Scenario 2 – Part 1: A 54-year-old male, ESKD on maintenance hemodialysis for three years, who underwent parathyroidectomy 12 months ago, was asked to participate in a bone biopsy pilot study, investigating the spectrum of bone histopathological changes in patients who underwent parathyroidectomy through the past twelve months. The patient’s labs are shown in table […]

Scenario 1 – Part 2: The vitamin D level was 14 ng/ml.The patient has been started on 50000 IU of ergocalciferol weekly and calcium carbonate. Six months later, the patient’s labs were as follows: Test Value S. Creatinine 3.7 mg/dL S. corrected Calcium 8.6 mg/dL Phosphorus 7.1 mg/dL PTH 400 pg/mL The patient had persistently […]

Scenario 1 – Part 1: A 52-year-old woman with end stage kidney disease secondary to hypertension complains of feeling increasingly bony aches and tiredness. She is currently receiving renal replacement therapy via hemodialysis. Her current medications include ramipril, aspirin, calcium carbonate and erythropoietin. On examination, the pulse rate is 73 – regular and the blood […]

Scenario 3 – Part 2: Calcium supplement and alfacalcidol were stopped. The patient was started on sevelamer 1600 mg.with meals TID Two months later, lab showed: Test Value S. Creatinine 5 mg/dl S. corrected Calcium 10.1 mg/dL S. Phosphorus 7.3 mg/dL iPTH 320 pg/mL   D- Are you happy with this response? and why? E- […]