Abstract
BackgroundOral sodium phosphate solutions (OSPS) are widely used for bowel cleansing prior to colonoscopy and other procedures. Cases of renal failure due to acute phosphate nephropathy following OSPS ingestion have been documented in recent years, questioning the safety of OSPS. However, the magnitude of the problem remains unknown.Methodology/Principal FindingsWe conducted a population based, retrospective analysis of medical records and biopsies of all cases of acute phosphate nephropathy that were diagnosed in our country in the period from January 2005 to October 2008. Utilizing the complete official sales figures of OSPS, we calculated the incidence of acute phosphate nephropathy in our country. Fifteen cases of acute phosphate nephropathy were diagnosed per 17,651 sold doses of OSPS (0.085%). Nine (60%) were women and mean age 69 years (range 56–75 years). Thirteen patients had a history of hypertension (87%) all of whom were treated with either ACE-I or ARB and/or diuretics. One patient had underlying DM type I and an active colitis and one patient had no risk factor for the development of acute phosphate nephropathy. Average baseline creatinine was 81.7 µmol/L and 180.1 at the discovery of acute renal failure, mean 4.2 months after OSPS ingestion. No patient had a full recovery of renal function, and at the end of follow-up, 26.6 months after the OSPS ingestion, the average creatinine was 184.2 µmol/L. The average eGFR declined from 73.5 ml/min/1.73 m2 at baseline to 37.3 ml/min/1.73 m2 at the end of follow-up. One patient reached end-stage renal disease and one patient died with progressive renal failure.Conclusion/SignificanceAcute phosphate nephropathy developed in almost one out of thousand sold doses of OSPS. The consequences for kidney function were detrimental. This information can be used in other populations to estimate the impact of OSPS. Our data suggest that acute phosphate nephropathy may be greatly underreported worldwide.
Highlights
Acute kidney injury (AKI) and subsequent chronic kidney disease (CKD) have been reported after bowel cleansing with oral sodium phosphate solutions (OSPS) [1]
Thirteen patients had a history of hypertension and all were treated with either angiotensin converting enzyme inhibitors (ACE-I) or angiotensin receptor blockade (ARB) (N = 10) and/or diuretics (N = 8) at the time of Oral sodium phosphate solutions (OSPS) bowel cleansing
Acute phosphate nephropathy is an iatrogenic cause of kidney injury after bowel cleansing with OSPS
Summary
Acute kidney injury (AKI) and subsequent chronic kidney disease (CKD) have been reported after bowel cleansing with oral sodium phosphate solutions (OSPS) [1]. The first biopsy proven case report of this toxic side effect on the kidneys was published in 2003 [3], 13 years after sodium phosphate solutions began to be used as a purgative for colonoscopy [4]. As OSPS has been a popular purgative for colonoscopy for almost 20 years in many countries it is possible that many individuals have suffered unrecognized acute and subsequent chronic kidney injury following ingestion of OSPS. Cases of renal failure due to acute phosphate nephropathy following OSPS ingestion have been documented in recent years, questioning the safety of OSPS.
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