Secondary hyperparathyroidism is a quite common complex alteration in bone and mineral metabolism that occurs as a direct result of chronic kidney disease. The patient presented in this case has stage 5 chronic kidney disease and has been undergoing hemodialysis therapy for almost a year. Secondary hyperparathyroidism was suspected due to laboratory exam alterations and confirmed through the radiographs shown above. Although she developed this complication only some months after the diagnosis of stage 5 chronic kidney disease, patients who are classified as stage 3 or 4 are already at risk for secondary hyperparathyroidism. The early identification and treatment of this condition is crucial to preventing or controlling the consequences of this complication.

Contributed by Dr. Guilherme Pioli Resende M.D. and Dr. Marcello Antônio de Rezende Basilio M.D.