Proptosis in a child with chronic kidney disease: Questions

Excerpt

An 8-year-old girl presented to the hospital with a complaint of pallor, and detected uremia. She was referred to the pediatric nephrology department due to uremia, and diagnosed with chronic kidney disease after investigations. She was the first child of consanguineous parents, and her past medical history was unremarkable. She was started on automated peritoneal dialysis (APD) due to end-stage renal disease of unknown etiology. After two years, she was transferred from APD to hemodialysis due to inadequate solute removal and ultrafiltration failure at the age of 10. The results of laboratory examinations were blood urea nitrogen (BUN), 98 mg/dl; serum creatinine, 9.14 mg/dl; calcium, 10.2 mg/dl; phosphorus, 6.0 mg/dl; alkaline phosphatase (ALP), 238 IU/l; parathyroid hormone (PTH), 483 pg/ml at initiation of hemodialysis. She was treated with daily oral calcitriol and phosphate binders, because of secondary hyperparathyroidism. …