KRONİK BÖBREK YETERSİZLİĞİ OLGUSUNDA OSTEOMALASİ: RENAL OSTEODİSTROFİYE Mİ BAĞLI YA DA BAŞKA SEBEPLER ARAYALIM MI?

Osteomalacia in a patient with ehronic renal failure: Caused by renal osteodvstrophy or is there any need to research other disorders? A 56 years ol d female patient was admitted to our elinic with the complaints of weakness and diffuse pain along the last year. Threc years ago, ehronic renal failure secondary to ehronic pyelonephritis that was complicated with renal oste-odystrophy were diagnosed and aetive oral vitamin D was given. The patient's physical exanıi-nation was unremarkabie. Laboratory examination revealed inereased serum alkaline phospha-tase, gamma-glutamyl transferasc and liver transaminases, together with moderate azotemia, hypophosphatemia, proîeinuria and glucosuria. Hypophosphotemia and glucosuria without hyperglycemia and osteomalasia could indicate Fanconi syndromc. On the other hand, liver bi-opsy was pcıformed due to the elevaled serum cnzyme levels, which showed findings of pri-mary biiiary cirrhosis (PBC). There may be more than onc reason for osteomalacia in the same patient. In PBC, malabsorption of vitamin D secondary to cholestasis İs the most common cau-se of osteomalacia followed by other rare conditions such as abııormal 25-hydroxylation of vitamin D due to hepatoeyte degeneration and renal tubular losses due to Fanconi syudrome as-sociatcd with autoimmunc and/or tubulointerstitial nephritis secondary to PBC. In our patient, both cirrhosis and osteomalacia could lıave itıcreased the serum alkaline phosphatase level.