Cargando…

Sevelamer Carbonate Crystal-Induced Colitis

Hyperphosphatemia is a common and well-described complication of end-stage renal disease. Despite strict dietary constraints and compliance, phosphate binders such as calcium acetate and/or sevelamer carbonate are also needed to treat secondary hyperparathyroidism. This case vignette describes an un...

Descripción completa

Detalles Bibliográficos
Autores principales: Lai, T., Frugoli, A., Barrows, B., Salehpour, M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396044/
https://www.ncbi.nlm.nih.gov/pubmed/32774946
http://dx.doi.org/10.1155/2020/4646732
_version_ 1783565508454383616
author Lai, T.
Frugoli, A.
Barrows, B.
Salehpour, M.
author_facet Lai, T.
Frugoli, A.
Barrows, B.
Salehpour, M.
author_sort Lai, T.
collection PubMed
description Hyperphosphatemia is a common and well-described complication of end-stage renal disease. Despite strict dietary constraints and compliance, phosphate binders such as calcium acetate and/or sevelamer carbonate are also needed to treat secondary hyperparathyroidism. This case vignette describes an underrecognized adverse effect of a phosphate binder, sevelamer carbonate, inducing colitis in a 47-year-old male with insulin-dependent diabetes complicated by end-stage renal disease. He presented for recurrent abdominal pain with associated nausea and was found to have multiple circumferential lesions on computed tomography including distal ascending, transverse, and proximal descending colon. Colonoscopy demonstrated nearly obstructing lesions worrisome for colonic ischemia or inflammatory bowel disease. Pathological review of histology demonstrated ragged colonic mucosa with ulcerative debris and nonpolarizing crystalline material at the sites of ulceration, morphologically consistent with the phosphate binder, sevelamer carbonate. Sevelamer carbonate was discontinued, and the patient was transitioned to calcium carbonate with strict dietary restrictions. His symptoms improved with the cessation of sevelamer, and he was subsequently discharged home. He eventually underwent renal transplant without redevelopment of symptoms. Recognition of this underreported complication of sevelamer carbonate, phosphate binder, is of utmost importance in directing appropriate therapy with cessation of this medication in the setting of gastrointestinal complaints or more specifically enteritis and colitis. Clinicians providing care to end-stage renal patients taking either sevelamer and/or sodium polystyrene sulfonate should have increased awareness of the possible gastrointestinal side effects.
format Online
Article
Text
id pubmed-7396044
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Hindawi
record_format MEDLINE/PubMed
spelling pubmed-73960442020-08-07 Sevelamer Carbonate Crystal-Induced Colitis Lai, T. Frugoli, A. Barrows, B. Salehpour, M. Case Rep Gastrointest Med Case Report Hyperphosphatemia is a common and well-described complication of end-stage renal disease. Despite strict dietary constraints and compliance, phosphate binders such as calcium acetate and/or sevelamer carbonate are also needed to treat secondary hyperparathyroidism. This case vignette describes an underrecognized adverse effect of a phosphate binder, sevelamer carbonate, inducing colitis in a 47-year-old male with insulin-dependent diabetes complicated by end-stage renal disease. He presented for recurrent abdominal pain with associated nausea and was found to have multiple circumferential lesions on computed tomography including distal ascending, transverse, and proximal descending colon. Colonoscopy demonstrated nearly obstructing lesions worrisome for colonic ischemia or inflammatory bowel disease. Pathological review of histology demonstrated ragged colonic mucosa with ulcerative debris and nonpolarizing crystalline material at the sites of ulceration, morphologically consistent with the phosphate binder, sevelamer carbonate. Sevelamer carbonate was discontinued, and the patient was transitioned to calcium carbonate with strict dietary restrictions. His symptoms improved with the cessation of sevelamer, and he was subsequently discharged home. He eventually underwent renal transplant without redevelopment of symptoms. Recognition of this underreported complication of sevelamer carbonate, phosphate binder, is of utmost importance in directing appropriate therapy with cessation of this medication in the setting of gastrointestinal complaints or more specifically enteritis and colitis. Clinicians providing care to end-stage renal patients taking either sevelamer and/or sodium polystyrene sulfonate should have increased awareness of the possible gastrointestinal side effects. Hindawi 2020-07-23 /pmc/articles/PMC7396044/ /pubmed/32774946 http://dx.doi.org/10.1155/2020/4646732 Text en Copyright © 2020 T. Lai et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Lai, T.
Frugoli, A.
Barrows, B.
Salehpour, M.
Sevelamer Carbonate Crystal-Induced Colitis
title Sevelamer Carbonate Crystal-Induced Colitis
title_full Sevelamer Carbonate Crystal-Induced Colitis
title_fullStr Sevelamer Carbonate Crystal-Induced Colitis
title_full_unstemmed Sevelamer Carbonate Crystal-Induced Colitis
title_short Sevelamer Carbonate Crystal-Induced Colitis
title_sort sevelamer carbonate crystal-induced colitis
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396044/
https://www.ncbi.nlm.nih.gov/pubmed/32774946
http://dx.doi.org/10.1155/2020/4646732
work_keys_str_mv AT lait sevelamercarbonatecrystalinducedcolitis
AT frugolia sevelamercarbonatecrystalinducedcolitis
AT barrowsb sevelamercarbonatecrystalinducedcolitis
AT salehpourm sevelamercarbonatecrystalinducedcolitis