title: Kidney injury after sodium phosphate solution beyond the acute renal failure.
abstract: OBJECTIVE
  Screening colonoscopy with polipectomy reduces colonorectal cancer incidence and mortality. An adequate bowel cleansing is one of the keys to achieving best results with this technique. Oral sodium phosphate solution (OSP) had a widespread use in the 90s decade. Its efficacy was similar to polyethylene glycol (PEG) solution, but with less cost and convenient administration. Series of patients with acute renal failure due to OSP use have been reported. However, large cohorts of patients found no difference in the incidence of renal damage between these two solutions.
  
  
  METHODS
  From 2006 to 2009 we identified twelve cases of phosphate nephropathy after colonoscopy prepared with OSP. All patients were followed up to six months. All patients had received just a single dose.
  
  
  RESULTS
  We analyzed 12 cases with phosphate nephropathy; three patients debuted with AKI and nine patients had chronic renal injury. Four cases were confirmed with renal biopsy. One patient with AKI needed hemodialysis at diagnosis without subsequent recovery. Two patients (both with chronic damage) fully recovered their previous renal function. The remaining patients (nine) had an average loss of estimated glomerular filtration rate of 24ml/min/1.73m(2).
  
  
  CONCLUSIONS
  The use of OSP can lead to both acute and chronic renal damage. However, chronic injury was the most common pattern. Both forms of presentation imply a significant and irreversible loss of renal function. Further studies analyzing renal damage secondary to bowel cleaning should consider these two different patterns of injury.
authors.affiliation: Department of Nephrology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain. Electronic address: gmfernandez@fhalcorcon.es.
authors.forename: Gema
authors.initials: G
authors.lastname: Fernández-Juárez
authors.affiliation: Department of Nephrology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain.
authors.forename: Leticia
authors.initials: L
authors.lastname: Parejo
authors.affiliation: Department of Nephrology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Villacorta
authors.affiliation: Department of Nephrology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Tato
authors.affiliation: Department of Nephrology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain.
authors.forename: Ramiro
authors.initials: R
authors.lastname: Cazar
authors.affiliation: Department of Pathology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Guerrero
authors.affiliation: Department of Nephrology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain.
authors.forename: Isabel Martinez
authors.initials: IM
authors.lastname: Marin
authors.affiliation: Department of Nephrology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Ocaña
authors.affiliation: Department of Nephrology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Mendez-Abreu
authors.affiliation: Department of Nephrology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain.
authors.forename: Katia
authors.initials: K
authors.lastname: López
authors.affiliation: Department of Nephrology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Gruss
authors.affiliation: Department of Nephrology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gallego
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000493:pharmacokinetics; D002130:Calcium Phosphates / Q000032:analysis; D002400:Cathartics / Q000009:adverse effects* / Q000493:pharmacokinetics; D003113:Colonoscopy; D003404:Creatinine / Q000097:blood; D004347:Drug Interactions; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000009:adverse effects* / Q000493:pharmacokinetics; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000959:Antihypertensive Agents; D002130:Calcium Phosphates; D002400:Cathartics; D010710:Phosphates; C020243:calcium phosphate; D003404:Creatinine; C018279:sodium phosphate
keywords: Chronic renal failure; Insuficiencia renal; Insuficiencia renal crónica; Nefropatía; Nephropathy; Renal failure