Achilles tendon rupture in a HD patient
medcases00
Published on Oct 28, 2021
CC- Achilles tendon rupture in a HD patient
HPI - A 37-year-old man with PMH of Ig A nephropathy, HTN, ESRD on HD for past 7 years. He has a history of chronic hyperphosphatemia. He has been on maximum dietary phosphate restriction, compliant with two phosphate binders, and is on high doses of zemplar for secondary hyperparathyroidism. While walking downstairs, the patient slipped step and immediately experienced a popping sound, followed by an immediate sharp pain in the back of his right ankle and lower leg. He has not been able to walk properly. A radiograph of the ankle showed no evidence of fracture, and the patient was prescribed analgesics. Right ankle pain persisted for several days, and he was unable to bear weight on his lower extremity -
EXAM - showed inability to stand on toes and has weak plantar flexion of the right ankle. Palpation showed tendon discontinuity around the posterior ankle
IMAGING -. MRI showed partial tear of Achilles tendon (Image)
LABS: serum phosphorus 9.5 mg/dl, serum corrected calcium 10.8 mg/dl, PTH 3004 pg/ml, and alkaline phosphatase 967 IU/L.
Next step in management is
A Surgical repair of Achilles tendon tear,
B) Surgical repair of Achilles tendon tear plus parathyroidectomy for renal osteodystrophy.
C) Surgical repair of Achilles tendon tear plus start Sensipar for renal osteodystrophy
D) Surgical repair of Achilles tendon tear plus Improve phosphorous control by dietary and adding additional binders
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https://renal.medcase.com/free_cme/238855/
