Phosphate nephropathy: Difference between revisions
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==[[Phosphate nephropathy causes|Causes]]== | ==[[Phosphate nephropathy causes|Causes]]== | ||
Revision as of 12:34, 12 June 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayesha Javid, MBBS[2]
Overview
Acute phosphate nephropathy is a form of renal injury that occurs as a result of consumption of bowel purgatives which contain oral sodium phosphate (OSP). It can lead to acute kidney injury followed by chronic renal failure. OSP is a commonly used purgative especially before colonoscopy.
Pathophysiology
Pathology
Causes
Epidemiology and Demographics
Gender
Several studies report, the majority of cases of acute phosphate nephropathy in the female gender. It could be related to their smaller heights and subsequently less GFR as compared to men.
Age
Several epidemiological studies have identified advanced age as an independent risk factor of acute phosphate nephropathy. Mean age of 64 years has been identified.
Ethnicity
A higher prevalence has been seen in whites.
Risk Factors
Dose of Oral Sodium Phosphate administered
The risk of acute phosphate nephropathy is directly related to the dose of Oral Sodium Phosphate (OSP) administered. The higher the dose administered, more will be blood phosphate levels and hence there would be a higher chance of harming kidneys and resulting in nephropathy.[1]
Chronic Kidney disease
A chronic kidney disease patient will have a decrease glomerular filtration rate (GFR). Oral Sodium Phosphate (OSP) administration is seen to increase the creatinine levels further worsening their kidney functions. Therefore, Oral Sodium Phosphate is contraindicated in chronic renal disease patients. Instead, polyethylene glycol (PEG) has been found to be a good alternative. [2]
Advanced age
Researchers agree that advanced age is an independent risk factor for acute phosphate nephropathy. One research shows the median age to be 64 years, however, although most studies agree on the advanced age is a strong risk factor, but are unable set a particular age limit.
Co-morbid conditions
Co-morbidities such as hypertension and diabetes mellitus have been found to further increase a patient's risk to acute phosphate nephropathy.
Drugs
The following drugs have been found to be a risk factor for acute phosphate nephropathy:[3] [4]
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria | History and Symptoms | Physical Examination | Laboratory Findings | Phosphate Nephropathy Biopsy | X ray | Ultrasound | Other Diagnostic Studies
Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
References
- ↑ Vanner SJ, MacDonald PH, Paterson WG, Prentice RS, Da Costa LR, Beck IT (1990). "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. 85 (4): 422–7. PMID 2183591 PMID 2183591 Check
|pmid=value (help). - ↑ Russmann S, Lamerato L, Motsko SP, Pezzullo JC, Faber MD, Jones JK (2008). "Risk of further decline in renal function after the use of oral sodium phosphate or polyethylene glycol in patients with a preexisting glomerular filtration rate below 60 ml/min". Am J Gastroenterol. 103 (11): 2707–16. doi:10.1111/j.1572-0241.2008.02201.x. PMID 18945285 PMID 18945285 Check
|pmid=value (help). - ↑ Heher EC, Thier SO, Rennke H, Humphreys BD (2008). "Adverse renal and metabolic effects associated with oral sodium phosphate bowel preparation". Clin J Am Soc Nephrol. 3 (5): 1494–503. doi:10.2215/CJN.02040408. PMC 4571150. PMID 18596115 PMID 18596115 Check
|pmid=value (help). - ↑ Ainley EJ, Winwood PJ, Begley JP (2005). "Measurement of serum electrolytes and phosphate after sodium phosphate colonoscopy bowel preparation: an evaluation". Dig Dis Sci. 50 (7): 1319–23. doi:10.1007/s10620-005-2780-9. PMID 16047480 PMID 16047480 Check
|pmid=value (help).