Kidneys- A vital organ of our body whose function is to clear the wastes of body. In case the kidney starts malfunctioning, the waste present in our body does not get discarded resulting in a variety of complications. One such condition is Acute Phosphate Nephropathy, in which there is damage to kidneys as a result of formation of phosphate crystals in renal tubules potentially damaging nephrons leading to potential Acute Renal Failure.1 In this article, we will read about the various factors leading to Acute Phosphate Nephropathy, the various symptoms, risk factors of Acute Phosphate Nephropathy.
How Is Acute Phosphate Nephropathy Defined?
According to the FDA, Acute Phosphate Nephropathy is a type of a kidney injury which is caused as a result of formation of calcium phosphate crystals in renal tubules, which has the potential to cause permanent damage to the renal function. Acute Phosphate Nephropathy is pretty rare, but a potentially serious event which has been associated with the use of Oral Sodium Phosphate (OSPs), which is generally used for bowel cleansing before a procedure.
Causes of Acute Phosphate Nephropathy
As mentioned, Acute Phosphate Nephropathy is generally associated with consumption of Oral Sodium Phosphate like C.B. Fleet's Phospho soda usually used for bowel cleansing before a colonoscopy procedure.1 The risk factor for developing Acute Phosphate Nephropathy is acutely increased with age, dehydration, or when an individual has hypertension.
Risk Factors for Acute Phosphate Nephropathy
Individuals with greatest risk for developing Acute Phosphate Nephropathy are people above the age of 50, already have a kidney function problem and have undergone dialysis. Also, people with electrolyte imbalance or other kidney diseases are at risk for developing Acute Phosphate Nephropathy.
Signs and Symptoms of Acute Phosphate Nephropathy
It is extremely important that people who take Oral Sodium Phosphates have knowledge of signs and symptoms of Acute Phosphate Nephropathy. Some of the signs and symptoms are:
- Abnormality in heart rates.
- Difficulty with urination.
- Extreme fatigue.
- Low back pain.
- Muscle spasms.
- Muscle cramping.
- Swelling of ankles and feet.
Diagnosis for Acute Phosphate Nephropathy
Acute Phosphate Nephropathy usually presents in the form of Acute Renal Failure with some amount of proteinuria in people who have recently consumed OSPs. When a kidney biopsy is conducted, it may reveal acute renal tubular damage, deposition of calcium phosphate crystals, etc. These pathological identifiers are consistent with a condition called Nephrocalcinosis.
What Factors Should A Healthcare Professional Consider Before Choosing A Bowel Cleanser For Patients?
Any physician should take the following precautions when choosing a bowel cleanser for patients:
- Avoiding usage of OSPs in people with prior kidney issues like renal function impairment, dehydration, or severe electrolyte imbalances.
- Avoiding exceeding the recommended dosage of OSPs
- Using OSPs cautiously in people who are taking medications like diuretics, ACE inhibitors and NSAIDs.
- Help the patients use the correct dosage of OSPs and consuming adequate amounts of fluids before a bowel cleansing procedure.
- Take baseline as well as postprocedure levels of electrolytes, calcium, phosphate, BUN, creatinine in people who are at increased risk for Acute Phosphate Nephropathy.
- In case if a patient is not strong enough because of advanced age or generalized weakness, then patient should be admitted in hospital. Seriously ill patients are treated by OSPs in a hospital under supervision.
How to Reduce Risk of Developing Acute Phosphate Nephropathy?
Patients can lower their chances of developing Acute Phosphate Nephropathy by:
- Taking OSPs only under guidance of a physician.
- Keep oneself adequately hydrated while taking OSPs.
- Having a thorough knowledge of the signs and symptoms of Acute Phosphate Nephropathy.
- Following up with the physician religiously.
- Avoid taking OSPs frequently.
Treatment for Acute Phosphate Nephropathy
Because the best treatment is still under research for Acute Phosphate Nephropathy, there is no clear cut treatment, but avoiding potential risk factors for Acute Phosphate Nephropathy can help a long way in preventing this potentially serious disease.
1. Phosphate induced crystal acute kidney injury - an under-recognized cause of acute kidney injury potentially leading to chronic kidney disease: case report and review of the literature.
Lochy S1, Jacobs R, Honoré PM, De Waele E, Joannes-Boyau O, De Regt J, Van Gorp V, Spapen HD.
Int J Nephrol Renovasc Dis. 2013 Mar 16;6:61-4. doi: 10.2147/IJNRD.S41428. Print 2013.
2. Is bowel preparation before colonoscopy a risky business for the kidney?
Nat Clin Pract Nephrol. 2008 Nov;4(11):606-14.