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Glen S. Markowitz - One of the best experts on this subject based on the ideXlab platform.

  • Phosphate enemas and GFR decline: it’s premature to sound the alarm
    Kidney international, 2016
    Co-Authors: Glen S. Markowitz, Andrew S. Bomback, Mark A. Perazella
    Abstract:

    Oral sodium Phosphate solutions can cause acute Phosphate Nephropathy, resulting in acute kidney injury and chronic kidney disease. A recent cohort study suggests that Phosphate enemas may also be associated with a decline in glomerular filtration rate, but further study is needed to establish a causal relationship.

  • Acute Phosphate Nephropathy.
    Kidney international, 2009
    Co-Authors: Glen S. Markowitz, Mark A. Perazella
    Abstract:

    Acute Phosphate Nephropathy (APhN) is a clinical pathological entity characterized by acute and subsequent chronic renal failure following exposure to oral sodium Phosphate (OSP) bowel purgatives. Renal biopsy findings include acute and chronic tubular injury with prominent tubular and interstitial calcium Phosphate deposits. Risk factors for APhN include older age, female gender, hypertension, chronic kidney disease (CKD), and treatment with angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. The pathomechanism of APhN involves hypovolemia-induced avid proximal salt and water reabsorption, delivery of a large Phosphate load to the distal nephron, and precipitation of calcium Phosphate in the distal tubule and collecting duct. To date, 37 cases of biopsy-proven APhN have been reported, and epidemiologic studies have produced inconsistent results regarding the incidence of acute kidney injury (AKI) following the use of OSP purgatives. OSP solution was withdrawn from the market in December of 2008, but OSP tablets, offered by prescription only, remain available. Prevention of APhN is best achieved by avoiding OSP in high-risk patients, aggressive hydration before, during, and after OSP administration, minimizing the dose of OSP, and maintaining a minimum of a 12 h interval between OSP administrations.

  • Oral sodium Phosphate bowel purgatives and acute Phosphate Nephropathy
    Clinical Nephrotoxins, 2008
    Co-Authors: Glen S. Markowitz
    Abstract:

    Phosphorus is a naturally-occurring element with an atomic number of 15 and an atomic mass of 31 g/mol. Within the human body, the majority of phosphorus is bound to 4 oxygen atoms, forming the Phosphate anion (PO4). As a result, the terms phosphorus and Phosphate are at times used interchangeably. Standard blood chemistries report the serum phosphorus with a normal range of approximately 2.5 – 4.5 mg/dl. This represents a measurement of serum Phosphate that has been corrected to reflect the molecular weight of phosphorus alone. A normal adult has a total body phosphorus content of 700-800 g [1]. The majority of Phosphate is present in bone, although approximately 15% is distributed outside of the skeleton where it is present in the form of inorganic Phosphate in extra-cellular fluid and organic Phosphates within cells, such as adenosine triPhosphate (ATP), nucleic acids, and membrane phospholipids. As such, phosphorus plays a vital role in numerous cell processes including cell energetics, cell membrane formation, and DNA & RNA synthesis, to name a few. Within blood, Phosphate exists mainly in two forms, HPO4 and H2PO4. These two anions are important serum buffers and their relative concentrations are determined by the serum pH. Oral sodium Phosphate bowel purgatives and acute Phosphate Nephropathy

  • Towards the Incidence of Acute Phosphate Nephropathy
    Journal of the American Society of Nephrology : JASN, 2007
    Co-Authors: Glen S. Markowitz, Jai Radhakrishnan, Vivette D. D'agati
    Abstract:

    In 2003, Desmeules et al. [1][1] reported a 71-yr-old female who developed acute renal failure after the use of an oral sodium Phosphate (OSP) solution as bowel purgative before colonoscopy. Renal biopsy revealed tubular injury and abundant tubular calcium Phosphate deposits, suggesting a

  • acute Phosphate Nephropathy following oral sodium Phosphate bowel purgative an underrecognized cause of chronic renal failure
    Journal of The American Society of Nephrology, 2005
    Co-Authors: Glen S. Markowitz, Barry M Stokes, Jai Radhakrishnan, Vivette D Dagati
    Abstract:

    The findings of diffuse tubular injury with abundant tubular calcium Phosphate deposits on renal biopsy are referred to as nephrocalcinosis, a condition typically associated with hypercalcemia. During the period from 2000 to 2004, 31 cases of nephrocalcinosis were identified among the 7349 native renal biopsies processed at Columbia University. Among the 31 patients, 21 presented with acute renal failure (ARF), were normocalcemic, and had a history of recent colonoscopy preceded by bowel cleansing with oral sodium Phosphate solution (OSPS) or Visicol. Because the precipitant was OSPS rather than hypercalcemia, these cases are best termed acute Phosphate Nephropathy. The cohort of 21 patients with APhN was predominantly female (81.0%) and white (81.0%), with a mean age of 64.0 yr. Sixteen of the 21 patients had a history of hypertension, 14 (87.5%) of whom were receiving an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The mean baseline serum creatinine was 1.0 mg/dl, available within 4 mo of colonoscopy in 19 (90.5%) patients. Patients presented with ARF and a mean creatinine of 3.9 mg/dl at a median of 1 mo after colonoscopy. In a few patients, ARF was discovered within 3 d of colonoscopy, at which time hyperPhosphatemia was documented. Patients had minimal proteinuria, normocalcemia, and bland urinary sediment. At follow-up (mean 16.7 mo), four patients had gone on to require permanent hemodialysis. The remaining 17 patients all have developed chronic renal insufficiency (mean serum creatinine, 2.4 mg/dl). Acute Phosphate Nephropathy is an underrecognized cause of acute and chronic renal failure. Potential etiologic factors include inadequate hydration (while receiving OSPS), increased patient age, a history of hypertension, and concurrent use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker.

Jack A. Dipalma - One of the best experts on this subject based on the ideXlab platform.

Eli D. Ehrenpreis - One of the best experts on this subject based on the ideXlab platform.

  • Renal risks of sodium Phosphate tablets for colonoscopy preparation: a review of adverse drug reactions reported to the US Food and Drug Administration.
    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2011
    Co-Authors: Eli D. Ehrenpreis, Deepak Parakkal, Rumi Semer
    Abstract:

    Aim  Sodium-Phosphate-containing colonoscopy preparations cause renal failure by the development of calcium Phosphate Nephropathy. Although Fleet’s Phospho-Soda has been removed from the US market, sodium Phosphate tablets sold as OsmoPrep and Visicol remain available. Our aim was to analyse renal risks of the sodium Phosphate tablets. Method  We conducted a retrospective study using the US Food and Drug Administration Adverse Event Reporting System, a voluntary reporting system available for public access. Renal adverse events were identified using search terms including renal impairment, increased blood urea nitrogen, increased creatinine, renal failure, acute renal failure, chronic renal failure, acute Phosphate Nephropathy, nephrocalcinosis, renal tubular necrosis, haemodialysis, Nephropathy toxic, dialysis, peritoneal dialysis, renal injury, renal tubular disorder, decreased glomerular filtration rate and decreased creatinine clearance. Patient age, gender and body weight were compared with data for the general population in the National Health and Nutrition Examination Survey (NHANES). Results  In total 2 097 223 files were extracted from the US Food and Drug Administration website for 2004–2008 and the first 9 months of 2009. Of these, 178 patients on tablet preparations (71% women) were identified, with increasing numbers of renal adverse drug reactions reported from tablet preparations each year. The mean weight for women with renal complications from tablet preparations was 68.57 ± 1.78 kg, significantly lower than the national average weight of 74 ± 0.5 kg for the same age group (P = 0.003) in NHANES. Conclusion  Renal adverse drug reactions from sodium Phosphate tablets are more common in women with a mean body weight lower than the national average weight.

  • Lower body weight and female gender: HyperPhosphatemia risk factors after sodium Phosphate preparations
    World journal of gastroenterology, 2011
    Co-Authors: Parakkal Deepak, Eli D. Ehrenpreis
    Abstract:

    Casais et al have reported an inverse correlation between serum Phosphate and body weight after administration of sodium Phosphate at a dose of 60 g. Our group has already described the relationship between body weight and hyperPhosphatemia with these preparations, although our study was not quoted by Casais. We performed a pharmacokinetic study involving 13 volunteers who were divided into two groups on the basis of body weight: group I consisting of seven women with a median weight of 60 kg and group IIconsisting of five men and one woman with a median weight of 119.2 kg. Group I developed higher peak Phosphate levels and maintained these levels above the subjects in Group II for a prolonged time period despite adequate hydration being ensured with frequent monitoring of weight, fluid intake and total body weight. Our study demonstrated that adequate hydration does not protect against the secondary effects of hyperPhosphatemia. In the study by Casais et al, 66% of the study subjects were women, the correlation between serum Phosphate and gender in their data also appears to be important. Women are at higher risk of acute Phosphate Nephropathy due to a diminished volume of distribution of the high dose of ingested Phosphate. Decreased volume of distribution in women is due to diminished body weight. This is further compounded by decreased creatinine clearance in females.

  • Calcium Phosphate Nephropathy from colonoscopy preparations: effect of body weight.
    The American journal of gastroenterology, 2010
    Co-Authors: Deepak Parakkal, Eli D. Ehrenpreis
    Abstract:

    in asymptomatic pancreatic hyperenzymemia . Pancreas 2009 ; 38 : 396 – 400 . 5 . Sarner M , Cotton PB . Classifi cation of pancreatitis . Gut 1984 ; 25 : 756 – 9 . 6 . Sainani NI , Conwell DL . Secretin-enhanced MRCP: proceed with cautious optimism . Am J Gastroenterol 2009 ; 104 : 1787 – 9 . 7 . Schmitz-Moormann HP , Hein J . Altersver a nderungen des pankreasgangsystems und ihre r u ckwirkungen auf das parenchym . Virchows Arch [Pathol Anat] 1976 ; 371 : 145 – 52 . 8 . Lankisch PG . Erh o hte Pankreasenzyme ohne erkennbare pankreaserkrankung . Dtsch Med Wochenschr 2009 ; 134 : 2232 – 5 . 9 . Imrie CW , King J , Henderson AR . Macroamylasemia — survey of prevalence in a mixed population . N Engl J Med 1972 ; 287 : 931 . 10 . Bode C , Riederer J , Brauner B et al. Macrolipasemia: a rare cause of persistently elevated serum lipase . Am J Gastroenterol 1990 ; 85 : 412 – 6 .

  • Increased serum Phosphate levels and calcium fluxes are seen in smaller individuals after a single dose of sodium Phosphate colon cleansing solution: a pharmacokinetic analysis
    Alimentary pharmacology & therapeutics, 2009
    Co-Authors: Eli D. Ehrenpreis
    Abstract:

    Summary Background  Sodium Phosphate containing colonoscopy preparations may cause electrolyte disturbances and calcium-Phosphate Nephropathy. Decreased body weight is an unexplored risk factor for complications with sodium Phosphate ingestion. Aim  To perform a pharmacokinetic analysis of a single dose of Fleet Phospho-Soda in smaller and larger individuals. Methods  Seven subjects weighing 100 kg (Group II) consumed 45 mL Fleet Phospho-Soda. Serum electrolytes were measured. Hydration was closely maintained by monitoring weight, fluid intake and total body water. Results  Marked increases in serum Phosphate were seen in Group I compared to Group II. For example, mean serum Phosphate at 120 min was 7.8 ± 0.5 mg/dL in Group I and 5.1 ± 0.8 mg/dL in Group II (P 

Russell W. Pelham - One of the best experts on this subject based on the ideXlab platform.

Jai Radhakrishnan - One of the best experts on this subject based on the ideXlab platform.

  • Gastrointestinal disorders and renal failure: exploring the connection
    Nature Reviews Nephrology, 2010
    Co-Authors: Shayan Shirazian, Jai Radhakrishnan
    Abstract:

    Gastrointestinal complications commonly occur in patients with renal failure. Upper gastrointestinal lesions, gastrointestinal bleeding, pancreatitis, and ischemic colitis are more common in patients with renal failure than in the general population. This Review describes the prevalence, etiologies, and treatment of the most common gastrointestinal complications associated with renal failure. The renal consequences of common gastrointestinal procedures are also discussed. Gastrointestinal symptoms occur in approximately 70% of patients with renal failure, probably owing to a high prevalence of 'functional' symptoms The prevalence of upper gastrointestinal lesions, acute and chronic gastrointestinal bleeding, pancreatitis, and ischemic colitis is higher in patients with renal failure than in the general population No clear association exists between dyspeptic symptoms and gastroparesis or Helicobacter pylori infection in patients with renal failure, which limits the value of screening for these entities in patients with renal failure Colonic necrosis has been reported after the administration of sodium polystyrene sulfonate–sorbitol preparations in patients with chronic kidney disease or end-stage renal disease; alternative treatments for hyperkalemia, such as dialysis or diuretic therapy should be used when possible Acute oxalate Nephropathy has been reported in patients who have undergone gastric bypass surgery; pre-existing kidney disease may be a risk factor for this complication Acute Phosphate Nephropathy can occur after administration of oral sodium Phosphate colonoscopy preparations; a reduced glomerular filtration rate may be a risk factor for this complication Gastrointestinal complications are known to commonly occur in patients with renal failure. Uremia and dialysis have long been speculated to increase the risk of lesions in the gastrointestinal tract and accessory organs. In addition, gastrointestinal procedures such as gastrointestinal bypass surgery and the administration of colonoscopy preparations can lead to the development of renal complications. Results from studies that have attempted to define the association between renal dysfunction and gastrointestinal complications are, however, conflicting and limited by small and varied sample populations. No clear management guidelines currently exist for many of the gastrointestinal problems that accompany renal failure. This Review examines the existing data on gastrointestinal complications in patients with chronic kidney disease and end-stage renal disease and aims to outline the etiology and management of common gastrointestinal disorders in such patients.

  • Towards the Incidence of Acute Phosphate Nephropathy
    Journal of the American Society of Nephrology : JASN, 2007
    Co-Authors: Glen S. Markowitz, Jai Radhakrishnan, Vivette D. D'agati
    Abstract:

    In 2003, Desmeules et al. [1][1] reported a 71-yr-old female who developed acute renal failure after the use of an oral sodium Phosphate (OSP) solution as bowel purgative before colonoscopy. Renal biopsy revealed tubular injury and abundant tubular calcium Phosphate deposits, suggesting a

  • acute Phosphate Nephropathy following oral sodium Phosphate bowel purgative an underrecognized cause of chronic renal failure
    Journal of The American Society of Nephrology, 2005
    Co-Authors: Glen S. Markowitz, Barry M Stokes, Jai Radhakrishnan, Vivette D Dagati
    Abstract:

    The findings of diffuse tubular injury with abundant tubular calcium Phosphate deposits on renal biopsy are referred to as nephrocalcinosis, a condition typically associated with hypercalcemia. During the period from 2000 to 2004, 31 cases of nephrocalcinosis were identified among the 7349 native renal biopsies processed at Columbia University. Among the 31 patients, 21 presented with acute renal failure (ARF), were normocalcemic, and had a history of recent colonoscopy preceded by bowel cleansing with oral sodium Phosphate solution (OSPS) or Visicol. Because the precipitant was OSPS rather than hypercalcemia, these cases are best termed acute Phosphate Nephropathy. The cohort of 21 patients with APhN was predominantly female (81.0%) and white (81.0%), with a mean age of 64.0 yr. Sixteen of the 21 patients had a history of hypertension, 14 (87.5%) of whom were receiving an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The mean baseline serum creatinine was 1.0 mg/dl, available within 4 mo of colonoscopy in 19 (90.5%) patients. Patients presented with ARF and a mean creatinine of 3.9 mg/dl at a median of 1 mo after colonoscopy. In a few patients, ARF was discovered within 3 d of colonoscopy, at which time hyperPhosphatemia was documented. Patients had minimal proteinuria, normocalcemia, and bland urinary sediment. At follow-up (mean 16.7 mo), four patients had gone on to require permanent hemodialysis. The remaining 17 patients all have developed chronic renal insufficiency (mean serum creatinine, 2.4 mg/dl). Acute Phosphate Nephropathy is an underrecognized cause of acute and chronic renal failure. Potential etiologic factors include inadequate hydration (while receiving OSPS), increased patient age, a history of hypertension, and concurrent use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker.