An unusual case of acute phosphate nephropathy (original) (raw)
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Phosphate nephropathy after administration of bowel purgative containing sodium phosphate – a
Polish Journal of Pathology, 2014
A65-year-oldwomanwasadmittedtothehospitalwithanelevatedserumcreatinineconcentrationassociatedwithleukocyturiaanderythrocyturia.Pastmedical historyanalysisrevealedthatfourmonthsbeforecurrenthospitalizationshehad beensubjectedtocolonoscopyprecededbytheadministrationoforalsodiumphosphate solution (OSP) as preparation for this procedure. Kidney biopsy revealed mildchronictubulo-interstitialinflammationandscarringwithprominentcorticaltubularcalciumphosphatedeposits.Thediagnosisofphosphatenephropathy, mostprobablysecondarytoOSPingestionwasmade.Duringfollow-uptherenal functionremainedimpairedbutstablewitheGFRof25ml/min/1.73m².Thepatientiscurrentlyunderthecareofthenephrologyclinic.
Extreme Hyperphosphatemia and Hypocalcemic Coma Associated with Phosphate Enema
Internal Medicine, 2008
Fleet enema (sodium phosphate, C.B. Fleet Co., Inc., Lynchburg, Virginia) is widely used for bowel preparation or constipation relief in the hospital and over the counter. The potential risks, including hyperphosphatemia and hypocalcemic coma should be kept in mind of primary care physician. The patients with older age, bowel obstruction, small intestinal disorders, poor gut motility, and renal disease are contraindicated or should be administered with caution. We present a patient with old age and chronic renal failure who developed severe hyperphosphatemia and hypocalcemic tetany with coma after sodium phosphate enema. We recommend the use of alternative enema preparations, such as simple tap water or saline solution enemas, which can prevent fatal complications in high risk patients.
Nephrocalcinosis, oral sodium phosphate solution, and phosphate nephropathy
2007
Nephrocalcinosis, a syndrome of renal parenchymal calcification, is associated with both acute and chronic kidney disease. Traditionally seen in patients with hypercalciuric disorders, medullary sponge kidney, or tumor lysis syndrome, recent reports have documented nephrocalcinosis following bowel preparation with oral sodium phosphate solution (OSPS), in a syndrome termed "phosphate nephropathy." This preventable complication is not benign; one retrospective series revealed that 20% of patients progressed to endstage renal disease (ESRD) with variable degrees of chronic kidney disease (CKD) in the remainder. Safe and effective bowel preparation is challenging and OSPS, while effective and generally well tolerated, can induce hyperphosphatemia, hypokalemia, metabolic acidosis, and volume depletion, in addition to renal calcification. The Federal Drug Administration (FDA), plaintiffs' attorneys, and the manufacturers of OSPS products have responded vigorously to the reports of kidney disease following OSPS. Although rare, internists, gastroenterologists, and nephrologists must be aware of this syndrome because it may be underdiagnosed and it is preventable by substituting OSPS with nonphosphate-containing preparative regimens in at-risk patients. This issue of Nephrology Rounds will address some of the gaps in our understanding of the incidence, risk factors, pathophysiology, and outcomes of phosphate nephropathy.
Renal Failure, 2013
Oral sodium phosphate-based laxatives are frequently used for bowel preparation or relief of constipation in some countries. However, these agents are not without risk. Small and clinical insignificant increments on serum phosphorus levels are observed in almost all individuals after use of oral sodium phosphate. Some patients are prone to severe hyperphosphatemia such as elders, those with chronic or acute renal disease and those with poor bowel motility. Severe hyperphosphatemia accompanied with hypocalcemia may be life-threatening in these patients. We present an 18-year-old woman with neuronal intestinal dysplasia who developed symptomatic and severe hyperphosphatemia after bowel preparation with oral sodium phosphate enema. Urgent hemodialysis was performed two times for severe hyperphosphatemia.
Phosphate disorders and the clinical management of hypophosphatemia and hyperphosphatemia
Endocrinología, Diabetes Y Nutrición (english Edition), 2020
Serum phosphorus levels range from 2.5 and 4.5 mg/dl (0.81-1.45 mmol/l) in adults, with higher levels in childhood, adolescence, and pregnancy. Intracellular phosphate is involved in intermediary metabolism and other essential cell functions, while extracellular phosphate is essential for bone matrix mineralization. Plasma phosphorus levels are maintained within a narrow range by regulation of intestinal absorption, redistribution, and renal tubular absorption of the mineral. Hypophosphatemia and hyperphosphatemia are common clinical situations, although changes are most often mild and oligosymptomatic. However, acute and severe conditions that require specific treatment may occur. In this document, members of the Mineral and Bone Metabolism Working Group of the Spanish Society of Endocrinology and Nutrition review phosphate disorders and provide algorithms for adequate clinical management of hypophosphatemia and hyperphosphatemia.