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Kidney Week

Abstract: SA-PO199

Two Cases of Brown Tumors in ESRD Patients

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Author

  • Bashir, Nihal, Seha Kidney Care- Tawam, Al Ain, United Arab Emirates
Introduction

Two patients among our dialysis cohort were diagnosed with brown tumors, one young male had disfiguring maxillary growth.

Case Description

Case 1
A 40-year-old female, known case of lupus nephritis and end stage renal disease on haemodialysis, and history of parathyroidectomy due to tertiary hyperparathyroidism. MRI of the lumbar spine in 2017 showed a well-marginated bone lesion involving the left iliac bone, measuring about 2 x 1.2 cm, second lesion is seen inferior to the former, measuring about 0.8 x 0.7 cm. Bone Scan showed delayed images show increased linear uptake in posterior left 12th rib and focal uptake at left eighth costochondral junction. There are foci of increased uptake in the cranium and mandible.DEXA scan showed T score of -3.1 and confirmed osteoporosis. Due to her Renal status - Bisphosphonate not suitable, other treatment options are Denosumab and Teriparatide but could not start neither of them as the patient had severe hypocalcaemia.Patient was started on teriparatide. Bone biopsy was negative for malignancy.
Case 2
A 27 year old male, known to have renal transplant 2006 reinitiated on haemodialysis in 2009. He also suffered secondary hyperparathyroidism of renal origin with Brown tumour of the facial bone with gross distortion with previous debulkking surgery, the patient is currently on etelcalcetide 7.5 mg intravenously on dialysis days. He had multiple disfiguring tumours as shown on images.

Discussion


Take home messages
1. Brown tumours are devastating and difficult to treat unless detected early in background of CKD- bone mineral disease.
2. Osteoporosis is difficult to diagnose and treat in ESRD patients.