Phosphate nephropathy or nephrocalcinosis[1] is an adverse renal condition that arises with a formation of phosphate crystals within the kidney's tubules. This renal insufficiency is associated with the use of oral sodium phosphate (OSP) such as C.B. Fleet's Phospho soda and Salix's Visocol, for bowel cleansing prior to a colonoscopy.[2]
According to the U.S. Food and Drug Administration (FDA), the potential risk factors of this complication include pre-existing kidney disease, increased age, female gender, dehydration, comorbidities such as diabetes mellitus and hypertension, and concurrent treatment with hypertensive medications (ACE inhibitors and angiotensin receptor blockers) and medications that affect renal perfusion (Nonsteroidal anti-inflammatory drug or NSAIDs and diuretics).[2] This complication can be diagnosed with renal tests and biomarkers in laboratories including histochemical staining of renal biopsy specimens,[3] the measure of creatinine level, GFR level, and urine output,[4][5] urine microscopy,[1] CT scanning,[6] and urinalysis.[3]
Phosphate nephropathy may also lead to further renal complications including acute kidney diseases and chronic kidney diseases, or the abrupt and gradual loss of kidney function over time.[7] Different management approaches involve the use of alternative bowel preparation agents and increasing patients' risk assessment among healthcare professionals, including nephrologists, gastroenterologists, and renal pathologists.[8] Other agents used for bowel preparation (e.g. magnesium citrate or PEG-3350 & electrolyte-based purgatives such as Colyte or Golytely) do not carry this risk.[4][8]
According to the U.S. Food and Drug Administration (FDA), "acute phosphate nephropathy is a rare, serious adverse event that has been associated with the use of OSPs. The occurrence of these events was previously described in an Information for Healthcare Professionals sheet and an FDA Science Paper issued in May 2006. Additional cases of acute phosphate nephropathy have been reported to FDA and described in the literature since these were issued."[2]
^ abHonore, Patrick; Lochy, Stijn; Jacobs, Rita; De Waele, Elisabeth; Joannes-Boyau, Olivier; De Regt, Jouke; Van Gorp, Viola; Spapen, Herbert (March 2013). "Phosphate induced crystal acute kidney injury – an under-recognized cause of acute kidney injury potentially leading to chronic kidney disease: case report and review of the literature". International Journal of Nephrology and Renovascular Disease. 6: 61–4. doi:10.2147/IJNRD.S41428. ISSN 1178-7058. PMC 3605970. PMID 23662071.
^ abcResearch, Center for Drug Evaluation and (2018-11-03). "Information on Oral Sodium Phosphate (OSP) Products for Bowel Cleansing (marketed as Visicol and OsmoPrep, and oral sodium phosphate products available without a prescription)". FDA.
^Heher, Eliot C.; Thier, Samuel O.; Rennke, Helmut; Humphreys, Benjamin D. (September 2008). "Adverse Renal and Metabolic Effects Associated with Oral Sodium Phosphate Bowel Preparation". Clinical Journal of the American Society of Nephrology. 3 (5): 1494–1503. doi:10.2215/CJN.02040408. ISSN 1555-9041. PMC 4571150. PMID 18596115.
^Markowitz, Glen S; Nasr, Samih H; Klein, Philip; Anderson, Herman; Stack, Jay I; Alterman, Lloyd; Price, Barbara; Radhakrishnan, Jai; D’agati, Vivette D (June 2004). "Renal failure due to acute nephrocalcinosis following oral sodium phosphate bowel cleansing". Human Pathology. 35 (6): 675–684. doi:10.1016/j.humpath.2003.12.005. PMID 15188133.
^ abDavies, Matthew R. P.; Williams, David; Niewiadomski, Olga D. (September 2018). "Phosphate nephropathy: an avoidable complication of bowel preparation for colonoscopy: Brief Communications". Internal Medicine Journal. 48 (9): 1141–1144. doi:10.1111/imj.14015. PMID 30182391. S2CID 52157398.
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