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Is bowel preparation before colonoscopy a risky business for the kidney?

Nature Clinical Practice Nephrology volume 4, pages 606–614 (2008)Cite this article

Abstract

Acute phosphate nephropathy after bowel preparation with oral sodium phosphate (OSP) for colonoscopy has emerged as an important clinical entity. In 2004, five cases of nephrocalcinosis and irreversible renal failure after bowel preparation with OSP were reported. More recently, several retrospective studies have shown that the incidence of acute kidney injury after OSP use is in the range of 1–4%, similar to the incidence of contrast nephropathy in the general population. The degree of renal failure is not generally as severe as in the first reported cases, but irreversible damage can still occur. Millions of people worldwide undergo screening colonoscopies for colon and rectal cancer after the age of 50, so careful patient selection and monitoring for possible complications is essential when OSP is used. In addition to educating patients about the possibility of renal damage, physicians should routinely watch for considerable weight loss during bowel preparation and correct the fluid deficit as needed. Carrying out a renal function panel, which includes serum phosphorus level, is prudent after colonoscopy. Alternative bowel cleansing agents are needed because calcium phosphate precipitation is inevitable after OSP use even in the normal kidney.

Key Points

  • Acute phosphate nephropathy (APN) can be diagnosed days or months after bowel preparation with oral sodium phosphate (OSP) before colonoscopy; specific symptoms or signs might not be present

  • Epidemiological studies reveal that APN occurs in 1–4% of patients with normal or near-normal renal function

  • The development of APN is directly related to the phosphate load imposed by OSP, which leads to production of calcium phosphate crystals and damage of renal epithelial cells

  • OSP also causes electrolyte abnormalities, including hyperphosphatemia, hypocalcemia, hypokalemia, hypernatremia, and hyponatremia

  • The standard OSP regimen should be modified by reducing, delaying or replacing the second dose with another bowel cleansing agent, to reduce toxicity

  • If OSP is used, the colonoscopy center should consider performing serum biochemistry tests after the procedure, in order to detect any renal or electrolyte abnormalities

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Figure 1: Time course of changes in serum and urinary phosphorus and calcium concentrations after standard doses of oral sodium phosphate.

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Acknowledgements

Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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  1. University of Arizona Health Sciences Center, 1501 North Campbell Avenue, Tucson, AZ 85724, USA lienhoward@gmail.com

Authors and Affiliations

  1. YH Lien is Professor of Medicine and Physiology at the University of Arizona, Arizona Kidney Disease and Hypertension Center, Tucson, AZ, USA.,

    Yeong-Hau H Lien

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Lien, YH. Is bowel preparation before colonoscopy a risky business for the kidney?. Nat Rev Nephrol 4, 606–614 (2008). https://doi.org/10.1038/ncpneph0939

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