The trinity of chronic kidney failure, hyperparathyroidism, and brown tumors: a case report

Introduction

Chronic kidney disease (CKD) is an irreversible progressive glomerular disease, and it can cause many complications like osteodystrophy, hyperparathyroidism (HPT), or bone lesions such as Brown Tumors (BT)

BTs are rare slow-growing lesions in skeletal and facial bones and are benign.

This paper describes a patient with tertiary hyperparathyroidism (THPT) and CKD-MBD who developed a large maxillary BT.

Case presentation

A 28-year-old male presented with swelling in the maxillary bone caused by secondary hyperparathyroidism (SHPT) after 14 years of chronic kidney disease (CKD). Radiological examinations confirmed the presence of a bone lesion localized to the maxillary bone, indicating a tumor, followed by histological tests confirmed the tumor was a brown tumor and the role of CKD and SHPT hypothesis involvement. The tumor was treated surgically after controlling the other underlying conditions.

Discussion

The impaired kidney function in Chronic kidney disease (CKD) leads to vitamin D deficiency and abnormal calcium and phosphorus levels, which stimulate the parathyroid glands to overproduce parathyroid hormone (PTH), and alteration in bone resorption and formation leading to bone lesions like BTs.

The diagnosis of brown Tumors is quite challenging and usually requires a combination of clinical and laboratory examination with imaging.

The cornerstone in treating BTs is managing the underlying HPT, which may involve medication, surgery, or both.

Conclusion

Brown Tumors are a late complication of hyperparathyroidism and chronic kidney disease. A thorough medical history is essential for early diagnosis and appropriate treatment of BTs.