Friday, September 30, 2005

Phosphate Nephropathy References

Acute Phosphate Nephropathy following Oral Sodium Phosphate Bowel Purgative: An Underrecognized Cause of Chronic Renal Failure. Journal of the American Society of Nephrology. 2005 Nov 1;16(11).
The findings of diffuse tubular injury with abundant tubular calcium phosphate deposits on renal biopsy are referred to as nephrocalcinosis, a condition typically associated with hypercalcemia. During the period from 2000 to 2004, 31 cases of nephrocalcinosis were identified among the 7349 native renal biopsies processed at Columbia University. Among the 31 patients, 21 presented with acute renal failure (ARF), were normocalcemic, and had a history of recent colonoscopy preceded by bowel cleansing with oral sodium phosphate solution (OSPS) or Visicol. Because the precipitant was OSPS rather than hypercalcemia, these cases are best termed acute phosphate nephropathy. The cohort of 21 patients with APhN was predominantly female (81.0%) and white (81.0%), with a mean age of 64.0 yr. Sixteen of the 21 patients had a history of hypertension, 14 (87.5%) of whom were receiving an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The mean baseline serum creatinine was 1.0 mg/dl, available within 4 mo of colonoscopy in 19 (90.5%) patients. Patients presented with ARF and a mean creatinine of 3.9 mg/dl at a median of 1 mo after colonoscopy. In a few patients, ARF was discovered within 3 d of colonoscopy, at which time hyperphosphatemia was documented. Patients had minimal proteinuria, normocalcemia, and bland urinary sediment. At follow-up (mean 16.7 mo), four patients had gone on to require permanent hemodialysis. The remaining 17 patients all have developed chronic renal insufficiency (mean serum creatinine, 2.4 mg/dl). Acute phosphate nephropathy is an underrecognized cause of acute and chronic renal failure. Potential etiologic factors include inadequate hydration (while receiving OSPS), increased patient age, a history of hypertension, and concurrent use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker.
Renal failure following bowel cleansing with a sodium phosphate purgative. Nephrol Dial Transplant. 2005 Apr;20(4):850-1.

Renal failure due to acute nephrocalcinosis following oral sodium phosphate bowel cleansing. Hum Pathol. 2004 Jun;35(6):675-84.

Acute phosphate nephropathy and renal failure. N Engl J Med. 2003 Sep 4;349(10):1006-7.

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Anonymous said...

I just ran across this article last week. For the past two years I have been trying to figure out how a healthy middle aged person can do a routine colonoscopy and end up in acute renal failure and now diagnosed with CRF with only about 50% kidney function. Does anyone know if this type of renal failure has a treatment that will help regain or improve kidney function? Is there any other information out there about this?

Test said...

I don't believe there are any treatments, but some reports suggest that renal function is likely to improve over time.

Anonymous said...

Sadley, the major manufacturer of the oral saline laxative bowel cleanser has known for years that this product,even when used by otherwise healthy individuals, can result in Acute Renal Failure, Chronic Renal Failure, nephrocalcinosis and End Stage Renal Disease.

Anonymous said...

Is there a web site or blog site where victims of Phosphate Nephropathy after colonoscopy can talk to each other? This happened to me and I am angry. Please respond. Thank You.