GG

1. Nephrology Resident
New Mansoura General Hospital

2.  Male patient named Ashraf Frg Muhamed
 ,44 years old from kfr sad
 ,married have 2 offsprings ,work as driver have no
special habits of medical importance
Personal history

3. Complaint
 Generalized bone aches , persistent itching 5
years ago

4.  The patient is known to be ESRD on regular
hemodialysis for 5 years 3 sessions/week 4
hours/session.
 The condition started 5 years ago in gradual
onset , progressive course of generalized bone
aches , persistent itching
 Patient soughed medical advice and
investigations were done and revealed elevated
serum calcium , phosphorus and PTH
Present history

5. Present history
PTHs.phs.cadate
19197.79.211/2015
>19006.510.49/2016
17905.310.91/2017
1730610.44/2017
>19005.8101/2018
>20006.59.76/2018
18695.910.910/2018

6. Trial of medical treatment
 Patient received one alpha 1mcg I.V for2 years
and calcium capsules but no improvement
 Also patient received sevelamer 1600mg po/day
for 1 month
 ,cinacalcet30 mg once /day for 1 month then
twice/day , but no response

7.  HB:11.5
 WBCS: 6
 PLATELETS:218
 INR: 1
 SERUM CA : 1.9 SERUM PHOSPHORUS : 6.8 PTH
1900
 SERUMALBUMEN :4
 SERUM CREATININE: 1.9 SERUM UREA: 80
 NA: 140 K:3.5
Pre-operative Lab

8. Cardiac consultation:
E C G: normal.
Pulse:72beat/min.
ABP:140/80mmHg.
No other abnormality detected.
 ENT consultation : normal freely mobile vocal
cords
Consultations

9. Decision
Parathyroidectomy is the ideal solution in cases of
ESRD with tertiary hyperparathyroidism after
failure of oral medical treatment.