Sprenger-Mähr H, et al. – Due to the lack of treatment recommendations for secondary hyperparathyroidism (sHPT) and preservation of bone health in pregnant dialysis patients, researchers describe the case of a young woman who developed end-stage kidney disease secondary to lupus nephritis and had multiple brown tumors while on hemodialysis during her second pregnancy. She had well-controlled sHPT and no skeletal complications during her first pregnancy. She suffered severe sHPT prior to the second pregnancy. An increment in dialysis time to 24 hours per week, administration of oral calcitriol, and setting dialysate calcium concentration at 1.5 mmol/L occurred during pregnancy. Bone pain in the left hip was experienced by the patient in week 20. A cystic lesion compatible with a brown tumor was seen on MRI. Cesarean section was performed, and the baby was delivered in the 36th week. Multiple brown tumors of her skeleton, including the acetabulum, tibia, ribs, skull, thoracic spine and thumb, were revealed on further evaluation. Multiple orthopedic surgeries were needed in this case. The initiation of etelcalcetide at 3 months post-pregnancy resulted in a gradual improvement in her sHPT. According to this case report, bone health can be affected in a deleterious manner by the combination of pregnancy and severe sHPT in dialysis patients.