Renal osteodystrophy presenting as ankylosing spondylitis: a case report

Abstract

Renal osteodystrophy is a common long term complication of end stage renal disease. We here by present a case of unusual presentation of renal osteodystrophy in young female who reported as chronic backache with stiffness.Case report- A 21 year's old, unmarried female presented with progressive low back pain and gradual restriction of movements of spine with no history of trauma. On basis of clinical presentation she was admitted with an impression of Ankylosing spondylitis. Her investigations revealed raised blood urea, serum creatinine and alkaline phosphatase with low calcium. In Xrays she was found to have pseudo fractures involving inferior ischiopubic ramii, dense vertebrae, mild coarsening of trabeculae and subperiosteal resorption in proximal phalanx of index and middle fingers. Ultrasound of KUB region revealed bilateral hypo plastic kidneys. All this led us to the diagnosis of Renal Osteodystrophy.In cases of ROD the children are always stunted in growth, often to a degree not equaled by any other form, our patient's growth was also stunted. It is stated that osteomalacia is a common component. This feature was also present in our case. By the time dialysis is required almost all patients are affected with ROD. This stood true in our case also as patient was referred for dialysis after establishing the diagnosis. In a normal scenario, patients of chronic renal disease are referred cases in orthopedics and usually on dialysis and then ROD is labeled.