International Journal of Urology and Nephrology Vol. 2 (2), pp. 052-054, August, 2014. Available online at www.internationalscholarsjournals.org © International Scholars Journals Case report Acute phosphate nephropathy due to use of phosphorous enema: Case report Jamshid Hamdard 1 , Rumeyza Kazancıoğlu 1 , Işın Kılıçaslan 2 , Yasemin Özlük 2 , Murat Alay 1 , Ruhper Çekin 1 and Reha Erkoç 1 1 Bezmialem Vakif University Faculty of Medicine, Department of Nephrology, Istanbul, Turkey. 2 Istanbul University Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey. Accepted 11 June, 2014 Acute phosphate nephropathy is a rare but serious type of kidney injury that commonly occurs after the use of bowel purgatives that contain oral sodium phosphate. Bowel purgatives are widely used to prepare patients for colonoscopy, but their use can cause acute or chronic kidney disease. Acute phosphate nephropathy is a type of crystal nephropathy characterized by tubular and interstitial deposition of calcium phosphate. Here we presented a case of acute kidney injury following the use of a sodium phosphate- containing enema who required a renal biopsy for diagnosis. Key words: acute phosphate nephropathy, acute kidney injury, oral sodium phosphate, crystal nephropathy, colon cleansing. INTRODUCTION Acute phosphate nephropathy, or nephrocalcinosis, is a type of tubulointerstitial nephropathy characterized by deposition of calcium phosphate crystals within renal tubules and the interstitium (Lochy et al., 2013). Oral sodium phosphate solutions are widely used for bowel cleansing before colonoscopy, for surgical procedures, and for treatment of severe constipation (Lochy et al., 2013; Weiss and Thop, 2011; Santos et al., 2010). These drugs must be used with caution among the elderly and among patients with renal dysfunction, small intestinal disorders, or poor gut motility. Acute phosphate nephropathy is a rare but serious condition which can cause acute kidney injury and progress to chronic kidney disease (CKD) (Weiss and Thop, 2011). Here, we presented a case of acute kidney injury following the use of sodium phosphate-containing enema. Case Our 67-year-old female patient was admitted to the hospital with complaints of nausea, vomiting, loss of *Corresponding author. E-mail: jamshidhamdard@hotmail.com appetite, and dysuria. She has a history of hypertension and type 2 diabetes mellitus. Two months before her admission to our clinic, she had gone to another hospital because of weakness. At that time her laboratory examinations revealed creatinin: 1.03 mg/dL, ESR: 89mm/h, CRP: 5.4mg/dl, leucocytes: 6,500/mm3, hemoglobin: 10.1 gr/dL, and hematocrit: 30%. A colonoscopy had been performed to investigate the patient’s anemia. Phosphorous enema had been administered to prepare the patient for colonoscopy. The colonoscopy was reported to be normal. At her presentation to our unit, the patient’s physical examination was unremarkable. Laboratory examination revealed glucose: 122 mg/dL, creatinin: 11.8 mg/dL, urea: 226 mg/dl, BUN: 105 mg/dl, sodium: 131 mmol/L, potassium: 4.5 mmol/L, Ca: 9.1 mg/dl, P: 7.3 mg/dl, Mg: 1.38 mg/dl, uric acid: 5.4 mg/dl, ESR: 66 mm/h, CRP: 1.2 mg/dl, leucocytes: 6.800 /mm3, hemoglobin: 9.3 gr/dL, hematocrit: 28.2%, thrombocyte: 324.000/mm 3 , MCV: 80 fL, Fe/TIBC: 62/294 ug/dL, ferritin: 329 ug/dL, and PTH: 338 pg/ml. Her venous blood gas results were pH: 7.25, PO 2 : 61 kpa, PCO 2 : 27 kpa, and HCO 3 : 19 mmol/l. Her urinalysis revealed a pH of 5, 18 white blood cells, a specific gravity of 1.010 (normal is 1.002-1.030), and 2+ glucose without ketones. During hospitalization the patient was rehydrated and three sessions of hemodialysis were performed before