Julian B A, Faugere M C, Malluche H H
Am J Kidney Dis. 1987 May;9(5):436-40. doi: 10.1016/s0272-6386(87)80149-x.
We report a patient on maintenance dialysis with oxalosis and radiographical signs typical of hyperparathyroid bone disease in patients with end-stage renal insufficiency. The patient underwent a subtotal parathyroidectomy. Because his bone pain worsened during long-term dialytic therapy, a bone biopsy was performed and revealed crystalline deposits in trabecules and the bone marrow characteristic of oxalate. Trabecular destruction and signs of defective mineralization of bone were also found. When the diagnosis was made, the patient had become addicted to narcotic analgesics; he died from an overdose. The case underscores the limits of skeletal radiographs for the diagnosis of oxalosis in bone. Furthermore, the radiographic findings may lead to erroneous conclusions in patients with renal osteodystrophy because the radiographic signs of oxalosis can mimic those of hyperparathyroid bone disease.
我们报告了一名维持性透析患者，其患有草酸盐沉着症，并具有终末期肾功能不全患者甲状旁腺功能亢进性骨病的典型影像学表现。该患者接受了甲状旁腺次全切除术。由于其骨痛在长期透析治疗期间加重，遂进行了骨活检，结果显示小梁和骨髓中有草酸盐特征性的结晶沉积物。还发现了小梁破坏和骨矿化缺陷的迹象。确诊时，该患者已对麻醉性镇痛药成瘾；他死于药物过量。该病例强调了骨骼X线片在诊断骨草酸盐沉着症方面的局限性。此外，对于肾性骨营养不良患者，X线检查结果可能会导致错误结论，因为草酸盐沉着症的影像学表现可模仿甲状旁腺功能亢进性骨病的表现。
