Rounds 8
The patient is a 44 y.o. woman who underwent renal transplantation ten years ago secondary to chronic glomerulonephritis. She now presents with progressive low back, left shoulder, hip, and knee pain. The pain has been steadily progressive over the past several months, does not radiate, is activity related, and has recently become so severe that she now has difficulty climbing stairs. She denies any other systemic symptoms except for a general feeling of "weakness", and the remainder of her past history is unremarkable.
Her current medications include Imuran, cyclosporine, and low dose prednisone. There are no obvious abnormalities on physical examination, but lower extremity neurological examination is difficult to perform due to pain. Laboratory examination reveals a serum creatinine of 3.5, calcium 10.2, phosphate 5.8, and a markedly elevated intact parathyroid hormone level at 1297 (nl range 10-65). Radiographs were obtained.
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ACR 2007 Highlights
Pathophysiology 2007