Sodium phosphate
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Renal failure in an elderly patient: case report A 66-year-old woman developed renal failure after receiving sodium phosphate for bowel cleansing prior to colonoscopy. The woman, who was receiving lisinopril and hydrochlorothiazide for hypertension, developed bloody diarrhoea. She received IV radiocontrast for a CT scan and oral sodium phosphate solution [dosage not stated]. A colonoscopy revealed colitis. After 1 week, she presented with malaise, nausea and renal failure. Laboratory tests revealed the following levels: serum creatinine 10.2 mg/dL; sodium 134 mmol/L; chloride 95 mmol/L; bicarbonate 20 mmol/L; calcium 9.8 mmol/L; uric acid 10.2 mg/dL and phosphate 25.4 mg/dL. Urinalysis showed one epithelial cell cast and specific gravity of 1.010. Large kidneys were revealed by ultrasonography. A renal biopsy showed widespread and numerous intratubular calcific concretions that had disrupted the tubular epithelium. Von Kossa stain accentuated the phosphate component of the concretions. She also had focal peritubular lymphocytic inflammation and minimal tubular damage, with coarse vacuolisation, occasional necrotic and sloughed epithelial cells, nuclear enlargement, loss of brush borders, occasional binucleation and nucleolar prominence. Electron microscopy confirmed tubular mineral deposits. She was diagnosed with phosphate nephropathy with mild acute tubular necrosis. The woman started receiving aluminium hydroxide. As her phosphorous level improved, she was switched to calcium acetate phosphate binding. Eventually, her creatinine level stabilised at 2.6 mg/dL. She had stage 4 chronic kidney disease. Her glomerular filtration rate was estimated to be 16 mL/min. She subsequently required treatment for anaemia and secondary hyperparathyroidism, but has not undergone dialysis. Beyea A, et al. Acute phosphate nephropathy following oral sodium phosphate solution to cleanse the bowel for colonoscopy. American Journal of Kidney 801071939 Diseases 50: 151-154, No. 1, Jul 2007 - USA
0114-9954/10/1160-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 14 Jul 2007 No. 1160
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