Secondary Hyper Parathyroidism, a Typical Mineral and Bone Disorder in a Chronic Hemodialysis Patient in Ziguinchor, Southern Senegal

Abstract

Mineral bone disorders (MBD) are almost constant complications in chronic hemodialysis patients. They cause an impairment in the quality of life and increase in cardiovascular morbidity and mortality. We are introducing the case of a 54-year-old woman, who was chronically on hemodialysis for 6 years, with a radial arteriovenous fistula as vascular access. Initially, the patient was reported having chronic tubulointerstitial nephritis. She was on hemodialysis three times a week. She developed secondary hyperparathyroidism. Clinically, she had diffuse arthralgias, bone pain mainly in the pelvis impeding walk; all this in a context of relative functional limitation of the lower limbs. As a result of paraclinical examination, serum calcium was 72 mg/l, phosphatemia was 42 mg/l. PTH returned to 2358 μg/ml and vitamin D tested using 25-OH-D was 20 mg/ml. Standard radiographs showed multiple geodes at the shoulder, lower extremity of the radius, trapezius, scaphoid, proximal phalanx head, spine and bilateral fracture lines of the femoral neck. Our patient was treated with calcium carbonate (e.g. Calcidia, in sachet), calcium-free phosphate binders (e.g. Renagel) and calcimimetics (e.g. Mimpara). Under medical treatment, there was a normalization of PTH and a decrease or even disappearance of the symptoms. This case shows that medical treatment for secondary hyperparathyroidism on hemodialysis patients, especially with calcimimetics, the use of which in our context is limited due to lack of availability.