title: Gastric mucosal status susceptible to lanthanum deposition in patients treated with dialysis and lanthanum carbonate.
abstract: Lanthanum carbonate is a popular chemical which is administered for patients with end-stage kidney disease to reduce the absorption of phosphate, and lanthanum deposition in the gastroduodenal mucosa has recently been reported. The aim of this study was to assess whether any histologic changes of the gastric mucosa are related to the deposition of lanthanum. Twenty-four patients who revealed the histology of lanthanum deposition on gastroduodenal biopsy between 2011 and 2014 were included in the study, and their clinical records and gastroduodenal biopsies obtained from 2011 to 2015 were reviewed, adding the review of gastroduodenal biopsies before 2011 if possible. Analysis of the deposited materials by scanning electron microscopy-energy dispersive x-ray spectroscopy was performed for a representative gastric biopsy. All patients were diagnosed as having renal insufficiency due to chronic kidney disease and treated with dialysis for more than 5 years, with confirmation of lanthanum carbonate use for 22 patients. Of 121 gastric biopsies and 10 duodenal ones between 2011 and 2015, 86 gastric biopsies (71.1%) and 3 duodenal biopsies (30%), respectively, revealed histology consistent with lanthanum deposition, which was confirmed by scanning electron microscopy-energy dispersive x-ray spectroscopy analysis for a representative case. The deposition tended to occur in the gastric mucosa with regenerative change, intestinal metaplasia, or foveolar hyperplasia (P<.05). Such mucosal changes were observed in about half of the gastric biopsy samples obtained prior to 2010, in which no lanthanum deposition was identified irrespective of the gastric mucosal status. Although direct association between lanthanum deposition and clinical symptoms is not clear, the evaluation of the gastric mucosal status (prior to administration) seems to be important to predict lanthanum deposition when lanthanum carbonate is administered for patients with chronic kidney disease treated with dialysis.
authors.affiliation: Department of Pathology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan; Department of Pathology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama, Japan. Electronic address: shinba@dokkyomed.ac.jp.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ban
authors.affiliation: Department of Nephrology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama, Japan.
authors.forename: Syunji
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Nephrology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kubota
authors.affiliation: Division of Morphological Science, Biomedical Research Center, Saitama Medical University, Moroyama, Iruma, Saitama, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Ohshima
authors.affiliation: Department of Pathology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Satoh
authors.affiliation: Department of Pathology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan; Department of Pathology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Imada
authors.affiliation: Department of Pathology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Ueda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects* / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000473:pathology / Q000628:therapy*; D007811:Lanthanum / Q000378:metabolism* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods; D013272:Stomach Diseases / Q000473:pathology
chemical_list: C119467:lanthanum carbonate; D007811:Lanthanum
keywords: Biopsy; Chronic kidney disease; Dialysis; Gastric mucosa; Lanthanum carbonate