Objective:

To present a case of renal osteodystrophy with significant skeletal manifestations, particularly focusing on the CT imaging findings.

Approach:

• Patient Presentation: A 45-year-old woman with chronic kidney disease stage 5D presented with abdominal pain and had a history of hemodialysis.
• Imaging Findings: CT showed bilateral renal atrophy, nephrolithiasis, and diffuse iliac and sacral osteosclerosis with near-complete bilateral sacroiliac ankylosis.
• Biochemical Evaluation: Biochemical tests indicated severe secondary hyperparathyroidism and vitamin D deficiency.

Key Findings:

• CT imaging revealed a bat-shaped pelvic appearance due to bilateral sacroiliac fusion.
• The patient exhibited severe secondary hyperparathyroidism and diffuse axial osteosclerosis.
• Absence of features suggestive of spondyloarthritis and negative HLA-B27 supported the diagnosis of renal osteodystrophy.

Interpretation:

The case illustrates the skeletal manifestations of renal osteodystrophy, particularly the unique CT appearance of sacroiliac ankylosis.

Limitations:

• Previous imaging was unavailable for review, preventing assessment of interval progression.

Conclusion:

This case broadens the recognized CT spectrum of renal osteodystrophy by illustrating near-complete bilateral sacroiliac ankylosis.