Download presentation
Presentation is loading. Please wait.
1
Renal biopsy case Niels Marcussen Odense University Hospital Denmark
2
Case history 77-year-old male was in January 2010 operated for colon adenocarcinoma. For many years he has been treated for hypertension with beta-blockers, diuretics and alfa-blockers. In April 2010 he underwent colonoscopy which did not show any signs of recurrent disease. Prior to the colonoscopy, he was orally given sodium phosphate (OSP) bowel purgative.
3
Case history II Two weeks later he was again admitted to hospital due to intestinal bleeding. At the time of admission his s-creatinine was 700 mol/l and after rehydration 450 mol/l. Proteinuria 1.1 g/d. No hyperphosphatemia or hypercalcemia. A renal biopsy was done in May 2010.
9
Immunofluorescense (normal) and Electron microscopy
10
Acute Phosphate Nephropathy (APhN) Described in 2003 by S. Desmeules et al. (N Engl J M 349:1006, 2003) Two weeks after ingesting phosphosoda a 71-year-old woman presented with malaise and elevated s- creatinine. Analysis of the renal biopsy by X-ray dispersion spectrum: Desmeules et al. 2003
11
Pathogenesis of APhN Massive phosphate intake Diarrhea-induced hypovolemia Decreased proximal tubular reabsorption of phosphate, especially following second dose of OSP Hypovolemia leads to salt and water reabsorption in the tubules Marked increase in Ca-Ph product in the distal tubular lumen Markowitz and Perazella KI 76:1027-34, 2009
12
Risk factors for APhN Advanced age Female gender Lower body weight Chronic renal disease Hypertension ACE-inhibitors, Angiotensin-receptor blockers, diuretics
13
Case II 77-years-old woman with known hypertension, treated with Ca-antagonist and diuretics was admitted with increased s- creatinine (224 mol/l). 3 months prior to admission her s- creatinine was 54 mol/l. The patient had 2 months prior to admission received OSP. Urine stix was negative for blood, 1+ for protein og 2+ for leucocytes. No hypercalcemia or hyperphosphatemia. Ultrasound normal. Renal biopsy was performed.
18
Clinical outcome Markowitz et al. 2005 and 2009: 21 patients – 4 progressed to end-stage renal failure. – 16 declined in s-creatinine to a mean of about 210 mol/l – 4 reached a creatinine of less then 176 mol/l No one returned to baseline.
19
APhN, pathological changes Acute changes (up to 3 weeks): – Acute tubular degenerative changes – Interstitial edema – Abundant tubular calcium phosphate deposits Chronic changes (after 3 weeks): – Tubular atrophy – Interstitial fibrosis – Abundant tubular calcium phosphate deposits
20
Acute phosphate nephropathy Diagnostic criteria: – AKI – Recent exposure to OSP bowel purgatives – Renal biopsy with characteristic findings – No hypercalcemia – No other known significant renal injury Markowitz & Perazella- Kidney Int 76:1027, 2009
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.