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February 1992

Pathological Case of the Month

Author Affiliations

From the Department of Pediatrics, University of Tennessee, Memphis (Dr Chesney) and the Departments of Pediatrics (Dr Friedman) and Pathology and Pediatrics (Dr Gilbert-Barness), Center for Health Sciences, University of Wisconsin, Madison.

Am J Dis Child. 1992;146(2):255-256. doi:10.1001/archpedi.1992.02160140121033

This 12-year-old girl had normal growth and development until age 5 years, when lethargy, nausea, vomiting, and pallor due to anemia developed. She had the features of uremia, with foul breath and facial edema. Laboratory values were as follows: serum calcium, 1.47 mmol/L; serum potassium, 5.9 mmol/L; and blood urea nitrogen, 71 mmol/L. Extensive nephrocalcinosis was evident on abdominal roentgenograms. The patient's height was 107 cm at age 5 years and failed to increase during the next 7 years (Fig 1). After 6 months of hemodialysis, the patient underwent a bilateral renal transplant. After a minor fall, a transverse fracture of the right femur at the level of the lesser trochanter (Fig 2) occurred. She was immobilized in a hip-spica cast, and her serum calcium level increased to 3.3 mmol/L. Her parathyroid hormone level was 11 mmol/L (in the normal range). A parathyroidectomy was performed in which three parathyroid glands

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