Elsevier

Human Pathology

Volume 38, Issue 1, January 2007, Pages 193-194
Human Pathology

Correspondence
Pathogenesis of nephrocalcinosis after sodium phosphate catharsis to prepare for colonoscopy: intestinal phosphate absorption and its effect on urine mineral and electrolyte excretion

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    Most renal phosphate reabsorption occurs in the proximal tubules, with only small amounts reabsorbed by the distal nephron. A study in 5 patients receiving OSP found a marked reduction in urinary calcium excretion that is consistent with calcium phosphate precipitation.4 Diagnostic criteria used for the identification of APN included the following: acute kidney injury, recent exposure to OSP, renal biopsy findings of diffuse tubular injury with abundant calcium phosphate deposits, no evidence of hypercalcemia, and no other significant pattern of renal injury.5

  • Acute phosphate nephropathy

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    Pathophysiologic factors thought to predispose patients to acute phosphate nephropathy include inadequate hydration, volume depletion and excessive OSPS dosing.12 Additionally, factors that are common in patients with acute phosphate nephropathy include female gender (this could perhaps be related to the greater degree of volume depletion caused by OSPS in the smaller body mass of elderly women9,15,16), older age, history of hypertension, diabetes, hyperparathyroidism and the use of angiotensin converting enzyme inhibitors. Angiotensin receptor blockers, diuretics, or non-steroidal anti-inflammatory drugs, exacerbate volume depletion, particularly in older patients.9

  • Acute phosphate nephropathy - An emerging threat

    2008, American Journal of the Medical Sciences
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    In 2001, phosphate balance studies in 5 healthy volunteers showed that 43% (!!!) of the ingested phosphate was absorbed by the intestine, whereas 15% appeared in the urine.16 Such an overwhelming amount of phosphate is not only excreted in the urine, but is likely to precipitate in renal tubules in the form of calcium–phosphate deposits.

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Potential Conflict of Interest: Dr. Fordtran receives royalties from Braintree Laboratories based on sales of isotonic lavage solutions, products which compete with sodium phosphate as a method to cleanse the colon.

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