Severe proximal myopathy in advanced renal failure. Diagnosis and management

Abstract

Myopathics encountered in uremic patients may have different pathogenetic mechanisms a n d treatment Secondary hyperparathyroidism m a y cause uremic myopathy responding to specific treatment. This study aimed at presenting a case illustrative of the clinical features, diagnosis a n d management of uremic parathyroid myopathy. A 66-year old man with renal failure from membranous nephropathy developed sensory signs of uremic neuropathy and progressive painless weakness of the pelvic girdle muscle s bilaterally. Motor nerve conduction velocity w a s normal, clcctromyogram was consistent with a myopathi c pattern, while muscle biopsy showed a pattern o f atroph y mor e consistent with a neuropathic pattern. Serologica l tests for collagen vascular diseases and hyperthyroidism wer e negative, while serum muscic enzyme s wer e not elevated and scrum phosphate levels wer e not low. Serum parathyroid hormone level wa s grossly elevated, while sci um calcium was mildl y elevate d in a smal l fractio n o f t h e measurements, serum alkaline phosphatas e showed a progressive rise and skeletal bon e survey did not disclose osteopenia or signs of parathyroid bone disease. A course of calcitriol failed to improv e the myopathy , which responde d promptl y a n d dramaticall y t o parathyroidectomy. Uremi c parathyroid myopathy, which has a characteristic clinical picture, must be differentiated from other neuropathic or myopathic conditions that require specific treatments. Progressive parathyroid myopathy is, by itself, a n indication parathyroidectomy, which is curative in this ease.