Renal osteodystrophy encompasses hyperparathyroidism, osteomalacia, osteoporosis, osteosclerosis, and soft tissue calcification. The radiographic signs of renal osteodystrophy are detectable in the hands, lateral ends of the clavicles, ribs, vertebrae, pelvis, long bones, and skull. Before dialysis and renal transplantation were introduced, bone disease with or without symptoms developed in patients who had irreversible renal glomerular failure in two main settings: adults with chronic uremia and bone disease and those patients whose lives were prolonged by skilled, conservative treatment, many of whom showed florid hyperparathyroidism. Many of the radiographic signs of azotemic osteodystrophy were described in this latter group of patients