Case 19-1970: Azotemia and Bone Disease Eighteen Years after Removal of a Parathyroid Adenoma

Presentation of Case First admission. A twenty-nine-year-old woman was admitted to the hospital because of pain in both costovertebral angles. One year previously she experienced flank pain, fever, chills, urgency of urination and nocturia and was treated with penicillin. A similar episode occurred six months later. Five days before entry pain and urgency of urination recurred in association with the passage of cloudy, foul-smelling urine. Gastrointestinal hemorrhage had occurred seven years, five years and one year before entry. Seven years before admission an upper gastrointestinal series demonstrated a duodenal ulcer and bilateral nephrocalcinosis. There was no history of renal.