Clin Exp Nephrol DOI 10.1007/s10157-015-1089-z
IMAGES IN NEPHROLOGY
Bilateral quadriceps tendon rupture in a hemodialysis patient Ayse Serra Artan • Barbaros Basgoze
Received: 8 July 2014 / Accepted: 26 January 2015 Ó Japanese Society of Nephrology 2015
Keywords Bilateral quadriceps tendon rupture Hemodialysis Secondary hyperparathyroidism A 41-year-old female presented to the emergency room with unability to stand and walk after a fall. She was hemodialysed for end stage renal disease due to chronic pyelonephritis since 15 years. Physical examination revealed inability to actively extend the knees and bilateral palpable suprapatellar gaps (Fig. 1). Laboratory tests showed a creatinine level of 12.4 mg/dl and a parathyroid hormone level of 1022 pg/ml. Lateral radiographs showed inferior displacement of both patellas (Fig. 2). Bilateral quadriceps tendon rupture is associated with medical diseases, trauma and certain medications. Diabetes mellitus, chronic renal failure, hyperparathyroidism, rheumatoid
arthritis, systemic lupus erythematosus, gout, chronic tendinopathies, quinolones, statins, anabolic steroids, and local and systemic corticosteroids are causative diseases and drugs. Rare cases after prolonged use of nasal corticosteroids and exposure to methidathion, an organophosphate are described.The cause in our patient was end stage renal disease with secondary hyperparathyroidism. Calcifications and subperiostal bone resorption due to secondary hyperparathyroidism may lead to tendon rupture with minor trauma or spontaneously. In this patient, bilateral patellar tendon repair was performed with an open surgery. Secondary hyperparathyroidism was treated medically. She regained her knee function after 6 months with the help of intensive physical rehabilitation exercises.
A. S. Artan (&) Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey e-mail: [email protected] B. Basgoze Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Clin Exp Nephrol Conflict of interest interest exists.
Fig. 1 Bilateral suprapatellar gaps are pointed by the arrows
Fig. 2 Arrows demonstrate inferior displacement of both patellas
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The authors have declared that no conflict of
IMAGES IN NEPHROLOGY
Bilateral quadriceps tendon rupture in a hemodialysis patient Ayse Serra Artan • Barbaros Basgoze
Received: 8 July 2014 / Accepted: 26 January 2015 Ó Japanese Society of Nephrology 2015
Keywords Bilateral quadriceps tendon rupture Hemodialysis Secondary hyperparathyroidism A 41-year-old female presented to the emergency room with unability to stand and walk after a fall. She was hemodialysed for end stage renal disease due to chronic pyelonephritis since 15 years. Physical examination revealed inability to actively extend the knees and bilateral palpable suprapatellar gaps (Fig. 1). Laboratory tests showed a creatinine level of 12.4 mg/dl and a parathyroid hormone level of 1022 pg/ml. Lateral radiographs showed inferior displacement of both patellas (Fig. 2). Bilateral quadriceps tendon rupture is associated with medical diseases, trauma and certain medications. Diabetes mellitus, chronic renal failure, hyperparathyroidism, rheumatoid
arthritis, systemic lupus erythematosus, gout, chronic tendinopathies, quinolones, statins, anabolic steroids, and local and systemic corticosteroids are causative diseases and drugs. Rare cases after prolonged use of nasal corticosteroids and exposure to methidathion, an organophosphate are described.The cause in our patient was end stage renal disease with secondary hyperparathyroidism. Calcifications and subperiostal bone resorption due to secondary hyperparathyroidism may lead to tendon rupture with minor trauma or spontaneously. In this patient, bilateral patellar tendon repair was performed with an open surgery. Secondary hyperparathyroidism was treated medically. She regained her knee function after 6 months with the help of intensive physical rehabilitation exercises.
A. S. Artan (&) Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey e-mail: [email protected] B. Basgoze Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
123
Clin Exp Nephrol Conflict of interest interest exists.
Fig. 1 Bilateral suprapatellar gaps are pointed by the arrows
Fig. 2 Arrows demonstrate inferior displacement of both patellas
123
The authors have declared that no conflict of
