title: A case report of sevelamer-associated recto-sigmoid ulcers.
abstract: BACKGROUND
  Optimal phosphorous control is an important aspect of the care of patients with end-stage renal disease, and phosphate binders are usually needed.
  
  
  METHODS
  A 74-year-old woman with end-stage renal disease on maintenance hemodialysis presented to the emergency room with abdominal discomfort, rectal pain, and blood-tinged stools. Initial concern was for a rectal carcinoma, based on the symptoms and imaging in initial computerized tomography of the abdomen showing rectal wall thickening, and her clinical presentation. She had been treated with the phosphate binder sevelamer for two months. In this case report, we explore the unique features of sevelamer-associated recto-sigmoid ulcers which led to her symptoms.
  
  
  CONCLUSIONS
  Sevelamer is widely used in chronic kidney disease and end-stage renal disease patients with hyperphosphatemia. It is a crosslinked polymeric amine that binds phosphates and bile acids; it is not systemically absorbed. To the authors' knowledge, this is the first reported case of recto-sigmoid ulcers associated with use of this phosphate binder. Nephrologists, pathologists, and gastroenterology sub-specialists should be aware of this recently-reported entity in patients on sevelamer with suggestive symptoms, as this medication is widely used in renal patients.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN, 55905, USA. Tieu.Christina@mayo.edu.
authors.forename: Christina
authors.initials: C
authors.lastname: Tieu
authors.affiliation: Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, 55905, USA. Moreira.Roger@mayo.edu.
authors.forename: Roger K
authors.initials: RK
authors.lastname: Moreira
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA. wong.louis@mayo.edu.
authors.forename: Louis M Wong Kee
authors.initials: LM
authors.lastname: Song
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA. Majumder.Shounak@mayo.edu.
authors.forename: Shounak
authors.initials: S
authors.lastname: Majumder
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA. Papadakis.Konstantinos@mayo.edu.
authors.forename: Konstantinos A
authors.initials: KA
authors.lastname: Papadakis
authors.affiliation: Division of Nephrology & Hypertension, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Hogan.Marie@mayo.edu.
authors.forename: Marie C
authors.initials: MC
authors.lastname: Hogan
mesh_terms: D000368:Aged; D002614:Chelating Agents / Q000009:adverse effects*; D012809:Colon, Sigmoid / Q000187:drug effects; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D011350:Proctocolitis / Q000139:chemically induced*; D012007:Rectum / Q000187:drug effects; D006435:Renal Dialysis; D000069603:Sevelamer / Q000009:adverse effects*; D014456:Ulcer / Q000139:chemically induced*
chemical_list: D002614:Chelating Agents; D000069603:Sevelamer