International Journal of Research in Medical Sciences | October 2020 | Vol 8 | Issue 10 Page 3715 International Journal of Research in Medical Sciences Andika GD et al. Int J Res Med Sci. 2020 Oct;8(10):3715-3719 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 Case Report Pathological fracture of subtrochanter femur, soft tissue infection along the fracture site, shaft femur bone cortex thickening and blastic lession on contralateral shaft femur due to renal osteodystrophy on the end stage renal disease patient: a case report Gde Dedy Andika*, Gede Ketut Alit Satria Nugraha, I. Made Sunaria, Putu Astawa, I. Gede Eka Wiratnaya, Made Agus Maharjana INTRODUCTION The traditional term for bone lesions in conjunction with chronic kidney disease (CKD) is ROD and is now considered a part of this disease. In the last decade, the number of CKD has increased consistently. Bone turnover abnormalities are well known in patients with CKD. These abnormalities encompass a spectrum from severely suppressed to markedly elevated bone turnover. In approximately 85% of patients with CKD stage 5 on dialysis, abnormal bone turnover occurs, and there is a greater risk of a bone fracture within this patient group than within the general population. The implication of this phenomenon is the number of pathological fractures of the bone increase as well. 1 ROD is skeletal complications that outcome from pathologic alterations in calcium, phosphate, and bone metabolism. Hyperphosphatemia and hypocalcaemia could result from impaired renal function. When the ABSTRACT Renal osteodystrophy (ROD) is a skeletal complication resulting from pathologic alterations in calcium, phosphate, and bone metabolism. The potential link between bone turnover and bone quality is an important question meriting study because of the relatively high incidence of fractures reported. In this case presents a pathological fracture on a routinely hemodialyzed woman. She complained pain on her left subtrochanteric area after low energy trauma accident. A thickening of the shaft femoral bone cortex was also found, reflecting the osteosclerosis event due to imbalance of proliferation and differentiation of osteoblast with increase bone formation. She also had a blastic lesion on her contralateral shaft femoral during the bone survey, but this finding remains asymptomatic. Decreased osteoclastic activity may contribute to cortical thickening, resulting in overall bone mass increase, which may lead to decreased elasticity of the bone or impaired repair capabilities, therefore increasing the risk of fracture. The blastic lesion that occurred on contralateral side may indicated effect of ROD or primary bone lesion. Careful assessment and holistic management of patients with kidney disease is necessary to achieve optimal outcome. The prevention of falls is also an important strategy to prevent pathological fractures. End stage renal disease (ESRD) have reduced bone mineral density, a risk factor for fracture incidence. Careful anamnesis and clinical examination are needed for diagnosis and management. Keywords: Case report, End stage renal disease, Pathological fracture, Renal osteodystrophy Department of Orthopaedics and Traumatology, Sanglah General Hospital, Faculty of Medicine, Udayana University, Bali, Indonesia Received: 10 August 2020 Accepted: 10 September 2020 *Correspondence: Dr. Gde Dedy Andika, E-mail: dedyandika.orthobali@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20204259