A Perfect Storm in Mineral Handling

Introduction One of the commonest complications of end‐stage renal disease (ESRD) is the disruption of normal mineral trafficking, with a major perturbation in the handling of calcium and phosphate. Background Here, we report a patient who presented some time ago along with his imaging, with some of the worst sequelae of these issues. This patient presented simultaneously with severe hyperparathyroidism, calcific uraemic arteriolopathy (CUA) with nonhealing skin ulcers, diffuse vascular calcification, uraemic tumoral calcinosis (UTC) with periarticular masses, proximal myopathy and erythropoietin resistant anaemia. Discussion We critically discuss new thinking around the pathogenesis, monitoring and potential therapeutic strategies for such patients if they present now, with new advances in our understanding and therapeutic approaches to such patients to avoid these awful complications of end‐stage renal failure.