Coincident Bilateral Atraumatic Hip Fracture in a Young Patient with Renal Osteodystrophy

Bilateral, coincident, atraumatic hip fracture is extremely uncommon and usually occurs secondary to seizures, trauma and metabolic disease including renal osteodystrophy. One of the major types, secondary hyperparathyroidism is associated with high bone turnover due to excess parathyroid hormone and usually seen in a chronic dialysis patient. We reported a 20-year-old woman with end stage renal failure and renal osteodystrophy. She sustained atraumatic right subtrochanteric fracture and left neck of femur fracture (Garden 1), then underwent bilateral long proximal femoral nail. Renal osteodystrophy causes pathological fracture by affecting calcium metabolism that stimulates bone resorptions and leads to osteoporotic bone. The aim of this case report is to discuss the approach and management done to the patient presented to our center. Bilateral long proximal femoral nail (PFN) was chosen, taking into account the patient’s premorbid, age, fracture pattern and potential complications. Careful multidisciplinary team approach led by the orthopaedic surgeon, nephrologist and physical therapist is vital for the patient to achieve good outcome postoperatively, thus reducing morbidity and mortality.

The Research Progression of Calcitonin for the Therapy of Renal Osteodystrophy

Calcitonin is a common medicine used in the treatment of osteoporosis,which could restrain the activity of osteoclasts,stop the loss of osteocalcin and reduce the transfer of osteocalcin.Calcitonin can also be used in the treatment of the pain-caused diseases which usually cause by hypercalcemia and others such like Paget's disease and bone tumors.As is approved by several clinic researches,calcitonin is powerful in adjusting the level of calcium,phosphorus and PTH during the treatment of renal osteodystrophy.In addition,it could improves the life quality of the patients who suffered from chronic kidney disease(CKD)and extending their life period.At present,several studies have shown us Calcitonin could be treated in renal osteodystrophy.However,the treatment experiences of Calcitonin are still lacking.Better understanding of the clinical evaluation for calcitonin in the treatment of renal osteodystrophy will hopefully help us to improve outcomes for these patients.

Changes of PTH, 1,25(OH)_2D_3 and Biochemistry in Renal Osteodystrophy.

The changes of plasma PTH, 1,25（OH）D, serum calcium, phosphorus and AKP were observed in 55 uremic patients with renal osteodystrophy. The results showed that: in all types of renal osteodystrophy, plasma PTH were markedly higher than normal （P<0.001）, while plasma 1,25（OHH）Dand serum calcium were lower than normal （P<0.001）. In low bone-turnover uremic osteodystrophy （LTO）, plasma phosphorus was markedly lower than that of high bone-turnover uremic osteodystrophy （HTO） and mixe d uremic osteodystrophy （MO） （P<0.05）, and plasma 1,25（OH）Dwas significantly lower than that of HTO （P<0.05）. In HTO and MO, serum phosphorus was much higher than mormal （P<0.001）. Plasma PTH had a negative linear correlation with plasma 1,25（OH）D（P<0.05）, a positive linear correlation with serum AKP （P<0.05）, but no linear correlation with the duration of hemodialysis, serum calcium, serum aluminum and bone aluminum content. Plasma 1.25（OH）Dhad no linear correlation with the duration of hemodialysis, seru

Recurrence of primary hyperoxaluria after kidney transplantation： the report of two cases

Primary hyperoxaluria （PH） is a rare autosoma recessive disorder of glyoxylate metabolism in which specific hepatic enzyme deficiencies result in overproduction of oxalate. Because oxalate is excreted exclusively by the kidney, hyperoxaluria leads to calcium oxalate nephrolithiasis, nephrocalcinosis, and renal failure. PH are considered rare with a prevalence of 0.1-0.2 per 106 population.2 PH was misdiagnosed in some cases initially and unfortunately a case may not be detected until the post-transplant period by allograft biopsy.