Medina-Liabres Kristianne Rachel Palanca, Kim Bo Mi, Kim Sejoong
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Gyeonggi-do, South Korea.
World J Clin Cases. 2020 Jun 26;8(12):2585-2589. doi: 10.12998/wjcc.v8.i12.2585.
Acute phosphate nephropathy (APN) is a disease that can occur when exposed to high doses of phosphate. The most common cause of APN is the use of oral sodium phosphate for bowel cleansing preparations. However, there are other less commonly known sources of phosphate that are equally important. To date, our literature search did not identify any report of excessive dietary phosphate as a cause of APN.
We report an unusual case of a 39-year-old diabetic male who presented with epigastric pain and oliguria. Work-up showed elevated serum creatinine, potassium, and calcium-phosphate product, and metabolic acidosis. The patient was admitted in the intensive care unit and received emergent renal replacement therapy. Kidney biopsy revealed tubular cell injury with transparent crystal casts positive for Von Kossa staining, which established the diagnosis of APN.
This case confirmed that APN may occur with other sources of phosphorus, highlighting the importance of good history taking and kidney biopsy in patients with predisposing factors for APN. Raising awareness on the possibility of APN and its timely recognition and management is imperative so that appropriate measures can be instituted to prevent or delay its progression to end stage renal disease.
急性磷酸盐肾病（APN）是一种在接触高剂量磷酸盐时可能发生的疾病。APN最常见的病因是使用口服磷酸钠进行肠道清洁准备。然而，还有其他一些不太为人所知的磷酸盐来源同样重要。迄今为止，我们的文献检索未发现任何关于过量饮食磷酸盐导致APN的报道。
我们报告一例不寻常的病例，一名39岁的糖尿病男性，出现上腹部疼痛和少尿。检查显示血清肌酐、钾和钙磷乘积升高，以及代谢性酸中毒。患者被收入重症监护病房并接受了紧急肾脏替代治疗。肾脏活检显示肾小管细胞损伤，伴有Von Kossa染色阳性的透明晶体管型，从而确诊为APN。
该病例证实APN可能由其他磷源引起，凸显了对有APN易感因素的患者进行详细病史询问和肾脏活检的重要性。提高对APN可能性的认识及其及时识别和管理至关重要，以便能够采取适当措施预防或延缓其进展至终末期肾病。
