Sternal instability in a hemodialysis patient with secondary hyperparathyroidism

Abstract

A 77-year-old man, 11 years under chronic hemodialysis treatment for chronic renal failure of unknown origin, presented with anterior chest pain, dyspnea with paradoxical breathing, and sternal instability after a simple fall from a standing height. Patient underwent three-vessel coronary artery bypass grafting 31 months ago. Computed tomography with three-dimensional volume rendering showed sternal nonunion with a great gap between the two halves of the sternum and at least one fracture in the left half of the sternum. A successful surgical repair followed. Patient suffered from severe secondary hyperparathyroidism for many years. Despite treatment with sevelamer, paricalcitol and cinacalcet, intact parathyroid hormone was 1682 pg/mL. During the last 5 years, serum intact parathyroid hormone remained steadily above 1000 pg/mL. Patient refused parathyroidectomy in the past. We assume that long-lasting severe hyperparathyroidism contributed to this rare and life-threatening complication of median sternotomy in our patient, due to the detrimental effect of hyperparathyroidism on bone metabolism and its association with increased incidence of bone fractures and defect in bone fracture healing.

Septicaemia among Children on Chronic Haemodialysis in a Renal Paediatric Setting in South Africa

“…For the diagnosis of CVC associated bacteraemia, blood, as well as catheter tip cultures are required [24]. A bacterial number higher than 100 cfu/ml in cultures obtained from the CVC and the concomitant development of the same bacterium in peripherial blood culture is a strong indication of CVC-associated bacteraemia [6].…”

“…It is well documented that Staphylococcus aureus and CNS are the commonest causes of blood septicaemia in HD patients [6,19,20,23,24,27,31]. Many of these studies show the predominant role of Staphylococcus aureus as a causative organism.…”

“…This is because of uremia, malnutrition, reduced responsiveness to vaccinations and impaired function of the cells of the immune system [3,4]. Infection is the second cause of death, after cardiovascular disorders, among patients with ESRD [5,6]. Septicaemia is mainly the primary cause of death whenever these cohorts of patients get infected, and it is also a leading cause of morbidity and mortality in children worldwide [5,7].…”