Adverse Renal and Metabolic Effects Associated with Oral Sodium Phosphate Bowel Preparation

Heher, Eliot; Thier, Samuel O.; Rennke, Helmut G.; Humphreys, Benjamin D.

doi:10.2215/cjn.02040408

Cited by 82 publications

(70 citation statements)

References 87 publications

(47 reference statements)

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“…The excess absorbed phosphate is then filtrated through the glomeruli, passed through the tubules, and is excreted into the urine, except when the concentration of phosphate in the primary urine exceeds its solubility, in which case calcium phosphate crystals are formed. These crystals form CPDs on tubular epithelial cells, leading to luminal obstruction (8) and also causing an immune reaction, tubular inflammation, and damage to the tubulointerstitial area (9). Previous studies of APhN reported diffuse, abundant CPDs obstructing the tubular lumens, thus supporting this hypothesis (Table 4).…”

Section: Discussionmentioning

confidence: 62%

Acute Phosphate Nephropathy with Diffuse Tubular Injury Despite Limited Calcium Phosphate Deposition

et al. 2016

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An 86-year-old woman developed acute kidney injury after colonoscopy. A renal biopsy showed diffuse tubular injury with minimal calcium phosphate deposits (CPDs), which were thought to be caused by an oral sodium phosphate bowel purgative before colonoscopy. According to these findings, she was diagnosed with acute phosphate nephropathy (APhN). In contrast to previous reports of diffuse tubular injury associated with tubular CPDs in APhN, this case demonstrated diffuse tubular injury despite a limited distribution of CPDs, suggesting that calcium phosphate can cause tubular injury without deposition. This case thus supports the hypothesis that urinary calcium phosphate crystals may cause tubular injury via other mechanisms, including inflammatory cytokines.Key words: acute phosphate nephropathy, oral sodium phosphate, colonoscopy, acute and reversible kidney injury, calcium phosphate crystal, drug-induced acute kidney injury

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Section: Discussionmentioning

confidence: 62%

Acute Phosphate Nephropathy with Diffuse Tubular Injury Despite Limited Calcium Phosphate Deposition

et al. 2016

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“…As NaP preparations have a low volume and are better tolerated, they are preferred more by clinicians. However, NaP solutions may cause severe fluid-electrolyte shifts and acute phosphate nephropathy (9,11).…”

Section: Discussionmentioning

confidence: 99%

Effects of Bowel Preparation and Fluid Restriction in Robot-Assisted Radical Prostatectomy Patients

Karaören¹,

Bakan²,

Yürük³

et al. 2015

Turk J Anesth Reanim

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Amaç: Robot yardımlı radikal prostatektomi (RYRP) ameliyatlarında preoperatif bağırsak hazırlığı ve intraoperatif sıvı kısıtlaması dehidratasyona ve elektrolit dengesizliğine neden olabilmektedir. Bu hastalarda yatış öncesi anestezi polikliniğinde "normal" olarak değerlendirilen labaratuvar değerleri anestezi uygulaması esnasın-da yanıltıcı olabilmekte ve hipokalsemi ve hipokalemiye bağlı kalp ritmi bozukluklarına, depolarizan blokta uzamaya ve anesteziden derlenmenin gecikmesine neden olabilmektedir. Biz çalışmamızda RYRP ameliyatlarında bağırsak temizliği ve sıvı kısıtlamasının preoperatif (T1) alınan labaratuvar değerleri ile ameliyat başlangıcın-da (T2) ve ameliyatın 6. saatinde (T3) alınan labaratuvar değerleri arasında bu tip yan etkilere yol açabilecek derecede farklılığa sebep olup olmadığını araştırmayı amaçladık.Yöntemler: American Society of Anesthesiologists (ASA) I-II 49 hasta uzerinde yaptığımız prospektif çalışmada hastaların bağırsak hazırlığı 12 saat içinde 2 defa rektal enema (NaP) ve tek doz oral soda (NaP) kullanılarak yapıldı. Ameliyat süresince 1 mL kg -1 h -1 %0,09 NaCl ve 1 mL kg -1 h -1 %6 HES 200/05 infüzyonları uygulandı.Bulgular: T2'de potasyum düzeyi T1 ve T3'e göre; T2 ve T3'teki kalsiyum düzeyi ise T1'e göre istatistiksel olarak anlamlı düşük saptandı. T3 kalsiyum değeri de T2'den anlamlı düşük, T3 kreatinin değeri ise T1 ile T2'den istatistiksel olarak yüksek saptandı.Sonuç: ASA I-II hasta grubunda yaptığımız çalışmamızda bağır-sak hazırlığı ve sıvı kısıtlamasına bağlı labaratuvar değerlerinde her ne kadar ciddi yükseliş ve düşüşler saptanmamış olsa da bu deği-şimler yüksek riskli ASA III-IV hastalarda önem taşıyabilir.Anahtar Kelimeler: Uzaktan operasyon (robotik), dehidratasyon, sıvı elektrolit imbalansı, barsak hazırlığı Objective: In Robot-assisted radical prostatectomy (RARP) patients, preoperative bowel preparation and intraoperative fluid restriction may cause dehydration and electrolyte imbalance. In these patients, laboratory results that are considered "normal" in the pre-anaesthesia clinic may be misleading, and cardiac arrhythmia due to hypokalaemia and hypocalcaemia, as well as problems, such as prolonged non-depolarising blockade and delayed recovery from anaesthesia, may be observed during anaesthesia practice. In this study, we aimed to determine these disturbances by comparing the preoperative (T1) laboratory values with those at the beginning of the operation (T2) and at the 6 th hour of the operation (T3) and values at discharge. Methods:This prospective study comprised 49 American Society of Anesthesiologists (ASA) I-II patients. Bowel preparation was made with a rectal enema (NaP) twice in 12 hours and with one single dose of oral laxative soda (NaP). During surgery, 1 mL kg -1 h -1 0.09% NaCl and 1 mL kg -1 h -1 6% HES 200/05 infusions were applied. Results:The potassium level at T2 was significantly lower than at T1 and T3. The calcium levels at T2 and T3 were significantly lower than at T1, and the level at T3 was significantly lower than at T2. The creatin...

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“…Endoscopists currently pay more attention to patients' comfort; for example, polyethylene glycol is being replaced by sodium phosphate for bowel preparation before colonoscopy [17] . However, recent reports have shown that phosphate nephropathy may complicate bowel preparation using sodium phosphate, even after a single preparation [18] . Another example is the use of propofol for sedation in replacement of benzodiazepines [19] .…”

Section: Discussionmentioning

confidence: 99%

Carbon dioxide for gut distension during digestive endoscopy: Technique and practice survey

Janssens¹,

Devière²,

Eisendrath³

et al. 2009

WJG

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AIM:To assess the adoption of Carbon dioxide (CO2) insufflation by endoscopists from various European countries, and its determinants. M E T H O D S :A s u r v e y w a s d i s t r i b u t e d t o 5 8 0 endoscopists attending a live course on digestive endoscopy. RESULTS:The response rate was 24.5%. Fewer than half the respondents (66/142, 46.5%) were aware of the fact that room air can be replaced by CO2 for gut distension during endoscopy, and 4.2% of respondents were actually using CO2 as the insufflation agent. Endoscopists aware of the possibility of CO2 insufflation mentioned technical difficulties in implementing the system and the absence of significant advantages of CO2 in comparison with room air as barriers to adoption in daily practice (84% and 49% of answers, respectively; two answers were permitted for this item). CONCLUSION:Based on this survey, adoption of CO2 insufflation during endoscopy seems to remain relatively exceptional. A majority of endoscopists were not aware of this possibility, while others were not aware of recent technical developments that facilitate CO2 implementation in an endoscopy suite.

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Adverse Renal and Metabolic Effects Associated with Oral Sodium Phosphate Bowel Preparation

Cited by 82 publications

References 87 publications

Acute Phosphate Nephropathy with Diffuse Tubular Injury Despite Limited Calcium Phosphate Deposition

Acute Phosphate Nephropathy with Diffuse Tubular Injury Despite Limited Calcium Phosphate Deposition

Effects of Bowel Preparation and Fluid Restriction in Robot-Assisted Radical Prostatectomy Patients

Carbon dioxide for gut distension during digestive endoscopy: Technique and practice survey

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