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Extreme scoliosis from CKD-MBD resulting in respiratory failure and death
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  1. Satoshi Akao1,
  2. Norihiro Nishioka2,
  3. Hitoshi Miyasato1,
  4. Mitsuyo Kinjo1
  1. 1Department of Internal Medicine, Okinawa Chubu Hospital, Uruma, Japan
  2. 2Department of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  1. Correspondence to Dr Mitsuyo Kinjo, kinjomitsuyo{at}gmail.com

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A 64-year-old man presented to our hospital because of dyspnoea. Twenty years ago, he had started peritoneal dialysis (PD) for chronic kidney disease. He had been diagnosed with secondary hyperparathyroidism 7 years before his presentation to our hospital, with an intact parathyroid hormone (PTH) 1227 pg/mL (normal range 10–60 pg/mL), calcium level of 10.1 mg/dL (normal range 8.8–10.5 mg/dL), phosphorus level of 5.5 mg/dL (normal range 2.4–4.1 mg/dL) and alkaline phosphatase level of 377 IU/L (normal range 140–338 IU/L). His medications included cinacalcet. Ultrasonography showed a 5-milimetre nodule at the lower pole of the parathyroid, but  99mTc-hexakis2- methoxyisobutylisonitrile (MIBI)scintigraphy revealed no abnormal accumulation.

The patient’s intact PTH increased to 2606 pg/mL 6 years prior to presentation. At that time, the patient deferred parathyroidectomy. A year later, he switched from PD to haemodialysis. Intact PTH remained elevated …

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