Renal osteodystrophy — SCE Rheumatology MCQ

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ModerateMetabolic Bone DiseaseRenal osteodystrophySCE Rheumatology

A 59-year-old man with CKD stage 5 has bone pain and pruritus. Calcium is low-normal, phosphate is high, PTH is markedly elevated and ALP is raised. DEXA is difficult to interpret because of vascular calcification. What is the most likely diagnosis?

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Correct answer: D — Secondary hyperparathyroid renal bone disease

Explanation lettering: C = shown as B · E = shown as C · B = shown as E

Secondary hyperparathyroid renal bone disease is best because advanced CKD with hyperphosphataemia, high PTH and raised ALP indicates secondary hyperparathyroid renal osteodystrophy. A is less suitable because hypoparathyroidism has low PTH; B is less suitable because primary osteoporosis does not explain phosphate and PTH abnormalities; C is less suitable because Paget disease is focal and usually has normal phosphate/PTH; E is less suitable because gout causes crystal arthritis rather than high-turnover renal bone disease. Clinical pearl: CKD-mineral bone disorder is biochemical as well as densitometric.

Reference: KDIGO CKD-MBD guideline; Oxford Textbook of Rheumatology