Lien Yeong-Hau H
University of Arizona, Arizona Kidney Disease and Hypertension Center, Tucson, AZ 85724, USA.
Nat Clin Pract Nephrol. 2008 Nov;4(11):606-14. doi: 10.1038/ncpneph0939. Epub 2008 Sep 16.
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.
口服磷酸钠（OSP）用于结肠镜检查肠道准备后出现的急性磷酸盐肾病已成为一个重要的临床实体。2004年，有报道称5例在使用OSP进行肠道准备后出现肾钙质沉着症和不可逆肾衰竭。最近，几项回顾性研究表明，使用OSP后急性肾损伤的发生率在1%-4%之间，与普通人群中造影剂肾病的发生率相似。肾衰竭的程度一般不像最初报道的病例那么严重，但仍可能发生不可逆损害。全球数以百万计的50岁以上人群接受结肠癌和直肠癌的筛查结肠镜检查，因此在使用OSP时，仔细选择患者并监测可能的并发症至关重要。除了告知患者肾脏损害的可能性外，医生还应常规观察肠道准备期间的显著体重减轻情况，并根据需要纠正液体不足。结肠镜检查后进行包括血清磷水平在内的肾功能检查是明智的。由于即使在正常肾脏中使用OSP后也不可避免地会发生磷酸钙沉淀，因此需要使用替代的肠道清洁剂。
