title: Adverse renal and metabolic effects associated with oral sodium phosphate bowel preparation.
abstract: Colorectal cancer can be prevented by the removal of adenomatous polyps during screening colonoscopy, but adequate bowel preparation is required. Oral sodium phosphate (OSP), an effective bowel purgative, is available over the counter and requires a substantially lower volume than polyethylene glycol-based preparative agents. Accumulating reports implicate OSP in electrolyte disturbances as well as acute kidney injury (AKI) in a syndrome termed phosphate nephropathy (a form of nephrocalcinosis). Despite published case reports and case series, the actual incidence, risk factors, and natural history of phosphate nephropathy remain largely undefined. Several recent observational studies have provided new information on these important issues while supporting a link between OSP and acute phosphate nephropathy as well as the development of chronic kidney disease in elderly patients, many of whom had a normal serum creatinine at the time of OSP ingestion. This review summarizes current knowledge about the renal complications of OSP, risk factors for its development, and the pathophysiology of acute and chronic kidney damage in nephrocalcinosis.
authors.affiliation: Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. eheher@partners.org
authors.forename: Eliot C
authors.initials: EC
authors.lastname: Heher
authors.forename: Samuel O
authors.initials: SO
authors.lastname: Thier
authors.forename: Helmut
authors.initials: H
authors.lastname: Rennke
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Humphreys
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000284:Administration, Oral; D001706:Biopsy; D002400:Cathartics / Q000008:administration & dosage / Q000009:adverse effects*; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D019317:Evidence-Based Medicine; D006801:Humans; D007015:Hypophosphatemia, Familial / Q000150:complications; D007674:Kidney Diseases / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology; D008659:Metabolic Diseases / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology; D009397:Nephrocalcinosis / Q000139:chemically induced; D010710:Phosphates / Q000008:administration & dosage / Q000009:adverse effects*; D011300:Preoperative Care / Q000009:adverse effects; D012307:Risk Factors; D013997:Time Factors
chemical_list: D002400:Cathartics; D010710:Phosphates; C018279:sodium phosphate