A 70 year old male, known case of chronic renal failure suffers from a pathological fracture of Rt femur, the diagnosis is -
Ans. is 'b' i.e., Secondary Hyperparathyroidism Secondary hyperparathyroidism (Renal osteodystrophy)o Bone and joint pain are common, as are limb deformities.o Pathological fractures are common.Diagnosiso The PTH is elevated due to decreased levels of calcium or 1,25-dihydroxy-vitamin D3. It is usually seen in cases of chronic renal disease.o Elavated creatinine and BUNCauseo Chronic kidney failure is the most common cause of secondary hyperparathyroidism. Failing kidneys do not convert enough vitamin D to its active form, and they do not adequately excrete phosphate. When this happens, insoluble calcium phosphate forms in the body and removes calcium from the circulation. Both processes lead to hypocalcemia and hence secondary hyperparathyroidism.Treatmento If the underlying cause of the hypocalcemia can be addressed, the hyperparathyroidism will resolve. In people with chronic renal failure, treatment consists of dietary restriction of phosphorus, supplements with an active form of vitamin D such as calcitriol, doxercalciferol, paricalcitol, etc. and phosphate binders which can be divided into calcium-based and non-calcium based.o In the treatment of secondary hyperparathyroidism due to chronic kidney disease on dialysis calcimimetics does not appear to affect the risk of early death It does decrease the need for a parathyroidectomy but caused more issues with low blood calcium levels and vomiting.o Most people with hyperparathyroidism secondary to chronic kidney disease will improve after renal transplantation, but many will continue to have a degree of residual hyperparathyroidism (tertiary hyperparathyroidism) posttransplant with associated risk of bone loss, etc.
Primary Hrperparathyroidism
Secondary Hyperparathyroidism
Scurvy
Vitamin D Resistant rickets
Renal Osteodystrophy