title: Renal risk associated with sodium phosphate medication: safe in healthy individuals, potentially dangerous in others.
abstract: BACKGROUND
  Sodium phosphate purgatives are used for bowel preparation before endoscopic or radiologic examination and occasionally for treatment of severe obstipation. Generally, they are well tolerated and effective; however, safety concerns exist regarding serious renal injury and electrolyte disturbances after administration of these drugs.
  
  
  METHODS
  The review presents complications associated with the use of agents containing sodium phosphate with regard to electrolyte disorders and renal impairment, namely acute phosphate nephropathy (APhN). This paper discusses the pathophysiology, histopathological findings, clinical symptoms, diagnosis and treatment of APhN. Additionally, it examines the epidemiology of adverse renal events and the safety of using sodium phosphate preparations prior to colonoscopy.
  
  
  CONCLUSIONS
  Because of safety concerns, sodium phosphate purgatives are not recommended for routine bowel cleansing. Despite some serious and even fatal adverse events associated with these drugs when used with at-risk patients, available data suggest that administration of sodium phosphate purgatives is relatively safe in nonrisk individuals(i.e., in adequately hydrated, otherwise healthy adults, younger than 55 years with evidence of normal renal function).
authors.affiliation: Charles University in Prague, 2nd Department of Internal Medicine, Third Faculty of Medicine , Ruská 87, 100 00 Prague 10 , Czech Republic +420 723 705 493, +420 267 162 703 ; iva.hoffmanova@fnkv.cz.
authors.forename: Iva
authors.initials: I
authors.lastname: Hoffmanová
authors.forename: Pavel
authors.initials: P
authors.lastname: Kraml
authors.forename: Michal
authors.initials: M
authors.lastname: Anděl
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control; D000328:Adult; D002400:Cathartics / Q000494:pharmacology*; D003113:Colonoscopy / Q000379:methods; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D058958:Organs at Risk; D010710:Phosphates / Q000494:pharmacology*; D020379:Risk Adjustment; D012307:Risk Factors; D014883:Water-Electrolyte Imbalance / Q000139:chemically induced / Q000517:prevention & control
chemical_list: D002400:Cathartics; D010710:Phosphates; C018279:sodium phosphate
keywords: acute kidney injury; acute phosphate nephropathy; bowel cleansing; colonoscopy; hyperphosphatemia; oral sodium phosphate; renal tubular necrosis; sodium phosphate medication