The complex pathophysiology of CKD-MBD involves a number of feedback loops between the kidney, parathyroid glands, bone, intestine, and vasculature, and usually commences early in the course of CKD prior to the onset of clinically detectable abnormalities in serum calcium, phosphate, PTH, and vitamin D levels [3–6]. Here, PTH is linked to Marchiafava-Bignami disease.