A 60 year old male was diagnosed with end stage kidney disease 5 years ago & has been managed with hemodialysis since then. He is also hypeensive & diabetic. He is not compliant with his medications & hemodialysis schedule & now presented with bone pain & dyspnea. CXR shows hazy bilateral infiltrates. Chest CT shows ground-glass infiltrates bilaterally. Lab studies show elevated levels of calcium & phosphate, PTH levels of 130 pg/ml. What would be the best management for this patient?

Given scenario suggests the diagnosis of teiary hyperparathyroidism- commonly seen in patients with chronic kidney disease who are poorly compliant with therapy. Features- bone pain, ectopic calcification & pruritus. Hypoxemia and ground-glass infiltrates on chest CT represent ectopic calcification of the lungs. A technetium-99 bone scan will show increased uptake in the lungs. Lab- Elevated calcium, phosphates & PTH levels Rx- Parathyroidectomy is done in this patient because of severe clinical manifestations.