title: Sevelamer crystals in the mucosa of the gastrointestinal tract in a teenager with end-stage renal disease.
abstract: BACKGROUND
  Non-calcium-containing phosphate binders, such as sevelamer preparations, are being increasingly used in patients on dialysis due to their lower association with hypercalcemia and cardiovascular morbidity and mortality. While minor gastrointestinal side effects are quite common with the use of sevelamer, more serious gastrointestinal toxicities have only rarely been reported.
  
  
  METHODS
  We report a pediatric patient on maintenance dialysis receiving sevelamer hydrochloride who developed severe abdominal pain and a high-grade stricture of the sigmoid colon. The patient underwent exploratory laparotomy, resulting in a partial colectomy and colostomy. Histopathologic examination showed colonic mucosal injury and characteristic "fish-scale"-like sevelamer hydrochloride crystals within the mucosa.
  
  
  CONCLUSIONS
  Whether the sevelamer crystals were causal, contributory or purely incidental remains to be clearly elucidated. However, our case raises sufficient concern to warrant additional investigation into whether there is a causal relationship between sevelamer use and intestinal mucosal injury.
authors.affiliation: Section of Pediatric Nephrology, Department of Pediatrics , University of California Davis Medical Center, 2516 Stockton Boulevard, Sacramento, CA, 95817, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
authors.affiliation: Section of Pediatric Nephrology, Department of Pediatrics , University of California Davis Medical Center, 2516 Stockton Boulevard, Sacramento, CA, 95817, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Olson
authors.affiliation: Section of Pediatric Nephrology, Department of Pediatrics , University of California Davis Medical Center, 2516 Stockton Boulevard, Sacramento, CA, 95817, USA. lbutani@ucdavis.edu.
authors.forename: Lavjay
authors.initials: L
authors.lastname: Butani
mesh_terms: D000293:Adolescent; D002614:Chelating Agents / Q000009:adverse effects*; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects* / Q000473:pathology; D041981:Gastrointestinal Tract / Q000187:drug effects* / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D007813:Laparotomy; D006435:Renal Dialysis / Q000009:adverse effects*; D000069603:Sevelamer / Q000009:adverse effects*; D013272:Stomach Diseases / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D002614:Chelating Agents; D000069603:Sevelamer
keywords: Chronic kidney disease; Crystal; Gastrointestinal toxicity; Hyperphosphatemia; Sevelamer carbonate; Sevelamer hydrochloride