Expert Opinion :
This child has presented with rickets, short stature, and anemia. The causes of rickets that one must consider are vitamin D-resistant rickets, chronic kidney disease (CKD), and renal tubular acidosis (RTA). Pallor is significantly seen in CKD and not seen in resistant rickets or RTA. Moreover, this child has high phosphorus which suggests secondary hypoparathyroidism and that is leading to hypocalcemia too. This hypoparathyroidism is seen in patients with CKD and can lead to renal osteodystrophy. Resistant rickets would lead to hyperparathyroidism and normal or low phosphorus whereas, in RTA, serum calcium, phosphorus, and alkaline phosphatase would be normal. Short stature may be the only presentation of CKD or RTA. Thus in this child, one should consider a diagnosis of CKD. The child’s creatinine was 8.4 mg% and BUN was 120 mg%. He had small kidneys on the ultrasound abdomen.