Abstract
A 33-year-old man on maintenance hemodialysis for 6 years for ESKD secondary to IgA nephropathy presented with acute back pain and loss of sensation in his feet, in the absence of recent trauma. His past medical history included severe hyperparathyroidism, with intact parathyroid hormone levels (iPTH) more than ten times the upper limit of the normal range (80 pg/ml) for 4 years, despite the prescription of phosphate binders, calcitriol, cinacalcet, and—lately—etelcalcetide. Clinical examination was marked by symmetric sensory loss and weakness in the lower extremities, together with deep-tendon hyperreflexia and Babinski signs. Plasma levels of electrolytes were normal. iPTH (855 pg/ml) and alkaline phosphatase (500 IU/L; normal range, 40–130 IU/L) levels were unchanged. Magnetic resonance imaging …
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