Original contributionRenal failure due to acute nephrocalcinosis following oral sodium phosphate bowel cleansing
Section snippets
Case 1
A 69-year-old Caucasian male presented with nonoliguric ARF. Past medical history was significant for hypertension for 2 years, a recent history of carcinoma of the prostate treated with radiation seed implants, radiation proctitis, and mild hyperparathyroidism. The patient’s only medications were losartan 100 mg once a day (QD) and folic acid 1 mg QD. Laboratory evaluation performed 6 weeks before the development of ARF revealed a serum creatinine level of 1.2 mg/dL, calcium level of 10.1
Results
The clinical findings in the 5 patients with ARF after use of OSPS are summarized in Table 1. The cohort comprised 2 males and 3 females, with a mean age of 69.2 years. All 5 patients had a past medical history of hypertension, and 2 had diabetes mellitus. Of note, patient 1 also had a history of hyperparathyroidism, a relative contraindication to the use of OSPS, although he had no evidence of hypercalcemia before colonoscopy. At the time of colonoscopy, 4 of the 5 patients were receiving
Discussion
Fleet Phospho-soda (CB Fleet) is an over-the-counter OSPS that is used both as a laxative and as a purgative for bowel cleansing before colonoscopy. When used as a purgative, the recommended regimen consists of 2 45-mL doses taken 12 hours apart, the night before and the morning of the colonoscopy procedure. Each 45-mL bottle contains 18.8 g of monobasic sodium phosphate and 4.3 g of dibasic sodium phosphate. Given the relatively small volume of OSPS required and the resultant effects, which
References (15)
- et al.
Metabolic and histologic investigation of the nature of nephrocalcinosis in children with hypophosphatemic rickets and in the Hyp mouse
J Pediatr
(1992) HistotechnologyA Self-Instructional Text
(1997)- et al.
The dysregulated podocyte phenotypeA novel concept in the pathogenesis of collapsing idiopathic focal segmental glomerulosclerosis and HIV-associated nephropathy
J Am Soc Nephrol
(1999) - et al.
A randomized prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation of patients for colonoscopy
Am J Gastroenterol
(1990) - et al.
Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods
Dis Colon Rectum
(1994) - et al.
Electrolyte disorders following oral sodium phosphate administration for bowel cleansing in elderly patients
Arch Intern Med
(2003) - et al.
Extreme hyperphosphatemia and acute renal failure after a phosphorus-containing bowel regimen
Am J Nephrol
(1999)
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