35 y/o F w h/o DM complains of pain in lower back, hips, and knees. Pt has ESRD and has been on HD for the last 2 years. Labs: Hb: 9.5, WBC: 6000, Platelets: 150K. Ca: 8.1, Phos: 6.1. What does she have and why?
Renal osteodystrophy - reduced GFR leads to phosphate retention and poorly processed vit D leads to hypocalcemia. Parathyroids respond by hypertrophying (secondary hyperparathyroidism)