A 47-year-old female presented after osteoporotic fracture of the left femoral neck 6 months earlier. Hip joint alloplasty was performed. In the medical history there was epilepsy, chronic kidney disease and tophaceous gout. At the visit the patient complained about weight loss, lack of appetite, muscle weakness. On examination there was no swollen joints, 38 tender joints, no tophi. She had telescopic fingers, her hand and feet x-rays revealed massive geodes and bone erosions. In laboratory tests parathormone was 1876 pg/mL (normal is 10 do 60 pg/mL), vitamin D 8 ng/mLl, Ca 4.5 mmol/L. The aim of the article is to discuss abnormalities in radiological images and laboratory tests of this patient. Medical history of the patient was analysed,7 references from PubMed database and one book were reviewed in September 2023. Secondary hyperparathyroidism in a patient with chronic kidney disease was diagnosed. The patient was consulted by an endocrinologist and qualified for parathyroidectomy.