Narula Ramesh

Address for correspondence* Dr. Narula Ramesh, MS (ORTH), FAIMER, Associate Professor of Orthopedics. Rohilkhand Medical College, Bareilly (UP), India. [email protected] e ISSN: 2277-7253 © 2012 Asian J Med Res Narula Ramesh, Salam Yasir, Iraqi Aftab Ahmed, Arya Anjana (Figure 1). Abduction and rotatary movements of both hips were also restricted. She was unable to sit cross legged and squat. Her cardiovascular, respiratory and abdominal examinations were normal. Subsequently she was admitted with a provisional diagnosis of Ankylosing Spondylitis. Patient was investigated for–hemoglobin , total and differential leukocyte counts, ESR, random blood sugar, S.G.P.T., RAFactor, C-reactive protein, serum uric acid, blood urea, serum creatinine, serum calcium, serum phosphorus, serum alkaline phosphatase, urine calcium and phosphorus estimation. She was found to have deranged renal function, as blood urea and serum creatinine were raised to 148 mg % and 5.0mg% .Her serum alkaline phosphatase markedly raised to 511 I.U./LIT. Her serum calcium was low 7.2 mg% and phosphate normal 6.0 mg %.( Table 1). Her X-ray pelvis revealed pseudo fractures involving both inferior ishiopubic rami (Figure 2). X-ray dorsolumbar spine revealed generalized increase in density (osteosclerosis) (Figure 3). Hand X-ray revealed early changes of renal osteodystrophycoarsening of trabeculae and subperiosteal resorption in proximal phalanx of index and middle fingers (Figure 4). Clinicoradiological diagnosis of Renal Osteodystrophy was made. Patient was then made to undergo ultrasound of KUB region which further revealed bilateral hypo plastic kidneys which further added to our diagnosis.