A 19-year old female patient has been treated with hemodialysis for the past 14 years after rejection of a cadaver transplant. Her original disease was Henoch-Schonlein purpura. She now presents with ascending pain and weakness in her hands and feet. There are prominent contractures of her extremities that have caused her to become bedridden over the last four months. Her major problems associated with hemodialysis had been hyperphosphatemia (7 to 8.5 mg/dl) and hypercalcemia (10 to 11 mg/dl) after vitamin D therapy. Her parathyroid hormone (PTH) levels are mildly elevated at 56 pg/ml, although they have been substantially higher in the past. A work-up for collagen vascular disease, including vasculitis, has been negative, as well as Lyme titer and thyroid function tests. Blood glucose has never been elevated. Electromyography and nerve conduction studies are normal. Muscle biopsy shows atrophy and intravascular calcification.
KeywordsCorrect Answer Phosphate Binder Pediatric Nephrology Renal Osteodystrophy Lanthanum Carbonate
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