Schoot Tessa S, Römkens Tessa Eh, Hoogeveen Ellen K
Department of Nephrology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands.
Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands.
SAGE Open Med Case Rep. 2021 Mar 15;9:2050313X211000488. doi: 10.1177/2050313X211000488. eCollection 2021.
Phosphate binders such as sevelamer are widely used in patients with chronic kidney disease to lower serum phosphate levels. We present a case of a 67-year-old woman with lower gastrointestinal bleeding after 9 days of using sevelamer carbonate (Renvela). Sigmoidoscopy revealed multiple deep ulcers (diameter 10-15 mm) and mucosal oedema. Histologic examination showed deposition of sevelamer crystals in these rectal ulcers. We hypothesized that the lower gastrointestinal bleeding was caused by deposition of sevelamer crystals. After cessation of sevelamer, gastrointestinal bleeding stopped. Deposition of sevelamer crystals in the gastrointestinal tract is a rare complication of sevelamer therapy. There are only 17 other recorded cases of gastrointestinal deposition of sevelamer crystals. This adverse effect should be considered in all patients taking sevelamer who present with gastrointestinal symptoms, such as gastrointestinal bleeding and abdominal pain. When sevelamer is discontinued, symptoms and mucosal damage appear to revert.
司维拉姆等磷结合剂被广泛用于慢性肾脏病患者以降低血清磷水平。我们报告一例67岁女性在使用碳酸司维拉姆（Renvela）9天后出现下消化道出血的病例。乙状结肠镜检查发现多个深度溃疡（直径10 - 15毫米）和黏膜水肿。组织学检查显示这些直肠溃疡中有司维拉姆晶体沉积。我们推测下消化道出血是由司维拉姆晶体沉积所致。停用司维拉姆后，消化道出血停止。司维拉姆晶体在胃肠道的沉积是司维拉姆治疗罕见的并发症。仅有另外17例司维拉姆晶体胃肠道沉积的记录病例。对于所有出现胃肠道症状（如消化道出血和腹痛）的服用司维拉姆的患者，均应考虑这种不良反应。停用司维拉姆后，症状和黏膜损伤似乎会恢复。
