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- […]
Scenario 3 – Part 1: A 40-years-old male, ESKD for10 years ago. H/O of low trauma fracture of Lt forearm and Lt hip. The patient was maintained on oral alfacalcidol 1 mcg per day and oral calcium gluconate 1000 mg per day. The following laboratory investigations revealed: Test Value S. Creatinine 5 mg/dL S. corrected […]
Scenario 2 – Part 2: The patient underwent reduction and fixation, and the hips were regularly monitored. She was started on vitamin D, calcium, and phosphate replacement. Three months later, the patient was still experiencing hip pains and was unable to ambulate without support. D- Would you recommend any further investigations and why? E- Discuss […]
Scenario 2 – Part 1: A 78-year-old female who had a 10-months history of hip pain and generalised muscle pain and weakness , presented with right femoral neck fracture. The patient was a strict vegetarian and homebound most of the time. X-ray revealed marked femoral bowing with cortical thickening and bending deformities of the sternum […]
Scenario 1 – Part 2: The patient underwent a bone biopsy which revealed high osteoid volume and normal lamellar architecture of bones. Approximately 80% of trabecular surfaces show aluminum deposit. D- What is the most likely diagnosis of this case according to his bone histomorphometry? E- How would you approach this case?
Scenario 1 – Part 1: A 72-year-old male with ESKD, who is maintained on HD for five years, complains of worsening bone pains through the past few months. The patient’s laboratory investigations are shown in table 1: Test Value iPTH 199 pg/ml corrected s. calcium 7.8 mg/dl S.po4 5.3 mg/dl alkaline phosphatase 187 U/L 25 […]
