Acute Phosphate Nephropathy and Renal Failure

Desmeules, Simon; Bergeron, Marc J.; Isenring, Paul

doi:10.1056/nejm200309043491020

Cited by 141 publications

(85 citation statements)

References 5 publications

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“…The associated tubular degenerative changes and the peritubular infiltration of lymphocytes and macrophages exactly mirror the pathology of biopsy-proven acute phosphate nephropathy in humans. 11,14,17,[27][28][29][30][31][32][33] Moreover, the presented animal model has manifold facets of overt hyperphosphatemia and of secondary hyperparathyroidism. Uninephrectomized db/db mice on the phosphorus-rich diet displayed not only elevated serum phosphorus and decreased serum calcium levels but also a strong secondary up-regulation of serum FGF23, 3 serum parathyroid hormone, and serum osteopontin levels.…”

Section: Discussionmentioning

confidence: 99%

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A Murine Model of Phosphate Nephropathy

Eller

Kirsch

et al. 2011

The American Journal of Pathology

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We established a murine model of phosphate nephropathy with secondary hyperparathyroidism. db/db mice, which develop obesity and type 2 diabetes mellitus, were uninephrectomized at the age of 6 weeks and were fed either standard chow or a phosphorus-rich diet during the next 8 weeks. Thereafter, renal cryosections showed abundant tubular casts with a strong histochemical von Kossa reaction in all db/db mice on the phosphorus-rich diet but none in the controls. X-ray diffraction and Raman spectroscopy proved that these tubular casts consist mostly of hydroxyapatite Ca 5 (PO 4 ) 3 (OH). These intraluminal precipitations were located in distal tubuli and collecting ducts and were associated with degenerative tubular changes and peritubular infiltration of T cells and macrophages. In line, kidneys of db/db mice on the phosphorus-rich diet displayed significantly increased mRNA expression of the T H 1 cytokines interferon ␥, IL-6, and tumor necrosis factor ␣. In addition, mice developed signs of secondary hyperparathyroidism as shown by elevated serum phosphate, decreased serum calcium, and increased parathyroid hormone, osteopontin, and fibroblast growth factor 23 levels. db/db mice on the phosphorus-rich diet also presented with significantly lower body weight, lower homeostasis model assessment of insulin resistance index, and hypertrophic cardiomyopathy. Thus, we provide a murine model of phosphate nephropathy and secondary hyperparathyroidism, which can be used for future pharmacologic and pathophysiologic studies to analyze the effect of hyperphosphatemia on renal, metabolic, and cardiovascular phenotypes.

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Section: Discussionmentioning

confidence: 99%

“…16 Most of our present information on phosphate nephropathy derives from case series and retrospective epidemiologic analyses. 11,14,[17][18][19] Moreover, there is no specific therapy for established phosphate nephropathy.…”

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confidence: 99%

A Murine Model of Phosphate Nephropathy

Eller

Kirsch

et al. 2011

The American Journal of Pathology

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“…5,6 Renal biopsy reveals an acute and chronic tubulointerstitial nephropathy with the distinctive finding of abundant tubular and interstitial deposits of calcium phosphate. In biopsies performed within 3 weeks of OSP exposure, findings of acute tubular injury predominate and resemble changes seen in acute tubular necrosis.…”

Section: Discussionmentioning

confidence: 99%

Findings of Biopsy-Proven Chronicity and End-Stage Renal Failure Associated with Oral Sodium Phosphate Solution

Cakar¹,

Kanbay²,

Sarlak³

et al. 2012

Renal Failure

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Bowel purgatives containing oral sodium phosphate (OSP) solution are used frequently in general practice and they have the potential of causing acute kidney injury especially in patients with some identified risk factors. Kidney injury may lead to chronicity and end-stage renal disease. Here we present, with renal biopsy findings, an elderly patient suffering from end-stage renal failure due to OSP solution.

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“…This may be related to the fact that in published studies, newborns were shown to manifest bone demineralization and bone growth failure because of maternal phosphate overload [10] , although a one time use in pregnancy has not shown to be detrimental. Another consideration when using phosphosoda preparations is the risk of phosphate nephropathy [12] , which has been reported in select cases.…”

Section: Discussionmentioning

confidence: 99%

Choice of laxatives and colonoscopic preparation in pregnant patients from the viewpoint of obstetricians and gastroenterologists

Jeevan¹,

Vinod²,

Jennifer³

et al. 2007

WJG

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AIM:To elucidate the preferences of gastroenterologists at our institution and compare them to those of obstetricians when making decisions in the pregnant patient, including which type of bowel preparations to use for flexible sigmoidoscopy or colonoscopy, as well as which laxatives can be used safely. METHODS:Surveys were mailed to all attending gastroenterologists (n = 53) and obstetricians (n = 99) at our institution. Each survey consisted of the 14 most common laxative or motility agents used in pregnancy and inquired about the physician's prescribing habits in the past as well as their willingness to prescribe each medication in the future. The survey also listed four common bowel preparations used prior to colonoscopy and sigmoidoscopy and asked the physician to rank the order of the preferred agent in each case. RESULTS:With regard to common laxatives, both gastroenterologists and obstetricians favor the use of Metamucil, Colace, and Citrucel. Both groups appear to refrain from using Fleets Phosphosoda and Castor oil. Of note, obstetricians are less inclined to use PEG solution and Miralax, which is not the case with gastroenterologists. In terms of comparing bowel preparations for colonoscopy, 50% of gastroenterologists prefer to use PEG solution and 50% avoid the use of Fleets Phosphosoda. Obstetricians seem to prefer Fleets Phosphosoda (20%) and tend to avoid the use of PEG solution (26%). With regard to bowel preparation for sigmoidoscopy, both groups prefer Fleets enema the most (51%), while magnesium citrate is used least often (38%). CONCLUSION:It is clear that preferences in the use of bowel cleansing preparations between the two groups exist, but there have not been many case controlled human studies in the pregnant patient that give clear cut indications for using one versus another drug. In light of the challenge of performing controlled trials in pregnant women, more extensive surveys should be undertaken to gather a larger amount of data on physicians' experiences and individual preferences.

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Acute Phosphate Nephropathy and Renal Failure

Cited by 141 publications

References 5 publications

A Murine Model of Phosphate Nephropathy

A Murine Model of Phosphate Nephropathy

Findings of Biopsy-Proven Chronicity and End-Stage Renal Failure Associated with Oral Sodium Phosphate Solution

Choice of laxatives and colonoscopic preparation in pregnant patients from the viewpoint of obstetricians and gastroenterologists

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