We describe a case of renal osteodystrophy presenting as an unresolved musculoskeletal injury. The injury from playing soccer had been treated unsuccessfully with conservative rehabilitation. Although the patient presented in a subtle way, his persistent symptoms high-lighted the need to search for other systemic problems. Once evident that he had a complex agglomeration of skeletal and radiologic abnormalities a diagnosis of chronic renal failure was made. The patient was subjected to immediate evaluation by a specialist in this hospital. Earlier diagnosis of children with renal osteodystrophy will result in more timely management of the associated metabolic and bony complications of this condition.