Resin-Induced ColonicPseudotumor: Rare Complication from Chronic Use of Potassium Binders in a Hemodialysis Patient

Abstract

Potassium-binding resins are widely used in the treatment of hyperkalemia, mostly in the acute setting. Gastrointestinal adverse events, although reported, are not frequently seen due to its short course of use. This report describes a case involving an end-stage renal disease patient on hemodialysis who developed a colonic mass after being on sodium polystyrene sulfonate chronically for persistent hyperkalemia. Gastrointestinal symptoms developed late during the treatment rather than early as reported previously in the literature. This mass was mistaken for a carcinomatous lesion, which initiated an extensive work-up as well as hospitalization that nearly resulted in a subtotal colectomy.

Pelvic inflammatory mass associated with sodium polystyrene sulfonate crystals diagnosed by endoscopic ultrasound‐guided fine needle aspiration cytology

“…1,3,4 There are three types of medical resins including bile acid sequestrants (BAS), potassium ion exchanger SPS and its counterpart calcium polystyrene sulfonate (CPS) and phosphate exchanger sevelamer. 1,3,4 Some are associated with gastrointestinal tract (GI) mucosal injury leading to mucosal erosion, necrosis, stenosis, perforation or formation of an inflammatory pseudotumor. [1][2][3][4][5][6] Deaths associated with SPS have also been reported.…”

“…1,3,4 Some are associated with gastrointestinal tract (GI) mucosal injury leading to mucosal erosion, necrosis, stenosis, perforation or formation of an inflammatory pseudotumor. [1][2][3][4][5][6] Deaths associated with SPS have also been reported. 1,3,5 In surgical pathology material, SPS and CPS appear as crystalline structures; basophilic with hematoxylin and eosin (H&E), blue with Diff-Quik (DQ) and magenta with periodic acid-Schiff and acid-fast stains.…”

“…Sodium polystyrene sulfonate is one of several non‐absorbable medication resins usually taken orally and used for ion exchange, most commonly in patients with chronic hyperkalemia 1,3,4 . There are three types of medical resins including bile acid sequestrants (BAS), potassium ion exchanger SPS and its counterpart calcium polystyrene sulfonate (CPS) and phosphate exchanger sevelamer 1,3,4 . Some are associated with gastrointestinal tract (GI) mucosal injury leading to mucosal erosion, necrosis, stenosis, perforation or formation of an inflammatory pseudotumor 1‐6 .…”

Challenges in Diagnosing Medication Resins in Surgical Pathology Specimens: A Crystal-Clear Review Guide

“…Kayexalate is well known for causing sometimes fatal bowel ischemia, ulcerations, necrosis, pseudotumors, and perforations. [3][4][5][6][7][8][9][10][11][12][13][14][15] The pathogenic properties of Kayexalate have long been attributed to its hyperosmotic sorbitol diluent and not the resins themselves. However, recent rat studies demonstrated that Kayexalate alone can result in fatal colonic necrosis, suggesting that the resins themselves may be pathogenic.…”

Esophageal Pseudotumor Secondary to Treatment with a Potassium Binder Resin: A Case of Severe Esophagitis Mimicking a Malignancy

“…Patients with prolonged use of potassium-binding resins who have chronic constipation or a mechanical obstruction may develop colonic necrosis due to long exposure of the resin to mucosa. Usually, the endoscopic lesions are ulcerations and erosions, although a few case reports have documented mass-like lesions in the colon mimicking malignancy [4,5]. Well-known risk factors for GI complications are uremia, end-stage renal disease, hemodynamic instability, kidney transplantation, gastrointestinal surgery, and constipation [3].…”