yemenjmedYemen Journal of MedicinecoVolume 1 Issue 2MultidisciplinaryEnglishJuly - December 2022NNY20250329ArticleA case of bilateral Achilles tendon spontaneous rupture in a hemodialysis patient: Who is the real culprit? Acidosis? Or hyperparathyroidism?EnglishY100102SaifullahKhanEnglishNMuftahOthmanEnglishYMohammad AminElesnawyEnglishY10.32677/yjm.v1i2.3642Patients who are on regular hemodialysis and who have advanced renal failure but have not yet started on renal replacement therapy have a high risk of tendon rupture, although this is a rare situation. We reported a case of 55-year-old male patient who had been on regular hemodialysis for the past 10 years. He presented with a sudden onset of pain and swelling in the left posterior ankle while climbing stairs. Ultrasonography revealed a complete disruption of the Achilles tendon, which was surgically repaired. His medical history was remarkable for the right Achilles tendon rupture a year ago. Investigations revealed tertiary hyperparathyroidism with chronic metabolic acidosis and high β-2 macroglobulin. With surgical repair, physiotherapy, and parathyroidectomy, the patient regained full active mobility. This case emphasized the importance of high parathyroid hormone level, metabolic acidosis, and high β-2 macroglobulin in the pathogenesis of tendons ruptures.EnglishAchilles tendon, Hemodialysis, High β-2 macroglobulin, Hyperparathyroidism, Rupturehttps://yemenjmed.com/admin/abstract?id=33References16191. Rao SK, Navadgi BC, Vasdev A. Bilateral spontaneous rupture of Achilles tendons: A case report. J Othop Surg (Hong Kong) 2005;13:178-80.2. Gawad MA. Spontaneous Achilles tendon rupture in a patient with undergoing long-term haemodialysis: A case report and literature review. Urol Nephrol Open Access J 2015;2:108-9.3. Park JH, Kim SB, Shin HS, et al. Spontaneous and serial rupture of both Achilles tendons associated with secondary hyperparathyroidism in a patient receiving long-term hemodialysis. Int Urol Nephrol 2013;45:587-90.4. Basic-Jukic N, Juric I, Racki S, et al. Spontaneous tendon ruptures in patients with end-stage renal disease. Kidney Blood Press Res 2009;32:32-6.5. Jones N, Kjellstrand CM. Spontaneous tendon ruptures in patients on chronic dialysis. Am J Kidney Dis 1996;28:861-6.6. Ureten K, Oztand;uuml;rk MA, Ozbek M, et al. Spontaneous and simultaneous rupture of both Achilles tendons and pathological fracture of the femur neck in a patient receiving long-term hemodialysis. Int Urol Nephrol 2008;40:1103-6.7. Hofmann GO, Weber T, Lob G. Tendon rupture in chronic kidney insufficiency-and;ldquo;uremic tendonopathyand;rdquo;? A literature-supported documentationand;nbsp;of 3 cases. Chirurg 1990;61:434-7.8. Spencer JD. Spontaneous rupture of tendons in dialysis and renal transplant patients. Injury 1988;19:86-8.9. Humbyrd CJ, Bae S, Kucirka LM, et al. Incidence, risk factors, and treatment of Achilles tendon rupture in patients with end-stage renal disease. Foot Ankle Int 2018;39:821-8.10. Ho LC, Chiang CK, Huang JW, et al. Rupture of pectoralis major muscle in an elderly patient receiving long-term hemodialysis: Case report and literature review. Clin Nephrol 2009;71:451-3.11. Uygur E, Erinand;ccedil; S, and;Ccedil;ift HT, et al. Bilateral spontaneous Achilles tendon rupture without any predisposing factors. Open J Orthop 2012;2:117-20.12. Syed S, Bhatti A, Shah MM. Spontaneous atraumatic Achilles tendon rupture in healthy individuals: Biomechanical aspect. J Coll Physicians Surg Pak 2009;19:195-7.13. Shiota E, Tsuchiya K, Yamaoka K, et al. Spontaneous mayor tendon ruptures in patients receiving long-term hemodialysis. Clin Orthop 2002;394:236-42.14. Bhole R, Flynn JC, Marbury TC. Quadriceps tendon ruptures in uremia. Clin Orthop Relat Res 1985;195:200-6.15. Ryuzaki M, Konishi K, Kasuga A, et al. Spontaneous rupture of the quadriceps tendon in patients on maintenance hemodialysis-report of threeand;nbsp;cases with clinicopathological observations. Clin Nephrol 1989;32:144-816. Murphy KJ, McPhee I. Tears of major tendons in chronic acidosis with elastosis. J Bone Joint Surg Am 1965;47:1253-8.17. Kurer MH, Baillod RA, Madgwick JC. Muscoloskeletal manifestations of amyloidosis: a review of 83 patients on haemodialysis for at least 10 years. J bone Joint Surg Br 1991;73:271-6.18. Trobisch PD, Bauman M, Weise K, et al. Histologic analysis of ruptured quadriceps tendons. Knee Surg Sports TraumatolArthrosc 2010;18:85-8.19. Hartgerink P, Fessell DP, Jacobson JA, et al. Full-versus partial-thickness Achilles tendon tears: Sonographic accuracy and characterization in 26 cases with surgical correlation. Radiology 2001;220:406-12.