Patient presents with signs and symptoms suggestive of secondary hyperparathyroidism (SHPT) secondary to chronic kidney disease (CKD).  The patient reports persistent fatigue, muscle weakness, bone pain, and pruritus.  Laboratory findings reveal elevated parathyroid hormone (PTH) levels, along with abnormalities in calcium, phosphorus, and vitamin D metabolism consistent with CKD-mineral and bone disorder (CKD-MBD).  The patient's estimated glomerular filtration rate (eGFR) indicates stage [Stage of CKD] chronic kidney disease.  Physical exam findings may include [Document specific findings, e.g., bone tenderness, calciphylaxis signs if present].  Diagnosis of secondary hyperparathyroidism is based on the combination of clinical manifestations, biochemical abnormalities, and underlying chronic kidney disease.  Differential diagnoses considered include primary hyperparathyroidism and other causes of hypercalcemia.  Treatment plan includes management of the underlying CKD, dietary phosphorus restriction, phosphate binders, calcimimetics if indicated, and vitamin D supplementation as appropriate.  Patient education provided regarding the importance of medication adherence, dietary modifications, and regular monitoring of PTH, calcium, phosphorus, and vitamin D levels.  Follow-up scheduled to assess treatment response and adjust management as needed.  ICD-10 code E83.81, Secondary hyperparathyroidism, is documented for medical billing and coding purposes.