Acute phosphate nephropathy after sodium phosphate preparations

doi:10.1136/bmj.a182

Published 17 July 2008, doi:10.1136/bmj.a182
Cite this as: BMJ 2008;337:a182

Practice

Lesson of the Week

Acute phosphate nephropathy after sodium phosphate preparations

Andrew Connor, registrar in renal medicine¹, Lucy Sykes, senior house officer in renal medicine¹, Ian S D Roberts, consultant histopathologist², Charles E Weston, consultant nephrologist¹

¹ Department of Renal Medicine, Dorset County Hospital, Dorchester DT1 2JY, ² Department of Cellular Pathology, John Radcliffe Hospital, Oxford OX3 9DU

Correspondence to: A Connor, 3 Hope Terrace, Martinstown, Dorset DT2 9JN andrewconnor1974@hotmail.co.uk

Predisposed individuals may develop chronic kidney disease afteradministration of sodium phosphate purgative before colonoscopy

The first 150 words of the full text of this article appear below.

Oral sodium phosphate preparations are used as bowel purgativesbefore colonoscopy. Subsequent renal impairment is increasinglybeing reported.¹ We describe a case of acute phosphate nephropathywith persistent renal impairment after administration of sodiumphosphate.

Case report

A 76 year old woman was admitted with rectal bleeding. Her pastmedical history included hypertension—treated with nifedipine—andlong standing use of tobacco. Physical examination was unremarkable.

Laboratory results were normal—haemoglobin 106 g/l, whitecell count 7.2x10⁹/l, platelets 357x10⁹/l, sodium 132 mmol/l,potassium 4.3 mmol/l, urea 6.2 mmol/l, and creatinine 98 µmol/l.

She underwent flexible sigmoidoscopy after being given a sodiumphosphate enema (Fleet Ready-to-use; De Witt) the night before(day 1). Colonoscopy was performed on day 4 after she took twosachets of oral sodium phosphate solution (Fleet Phospho-soda;De Witt). Histological findings were consistent with chronicactive ulcerative colitis. She was discharged and prescribedmesalazine.

On day . . . [Full text of this article]