Renal failure following bowel cleansing with a sodium phosphate purgative

Extract

Sir,

Visicol® Tablets (InKine Pharmaceutical Co., Inc.) have been used in >1.2 million patients as a bowel preparation for colonoscopy. To date, InKine Pharmaceuticals has received one report of nephrocalcinosis following use of Visicol®. This case was described by Markowitz et al. in the April 2005 issue of the journal along with 15 cases associated with the use of oral sodium phosphate solution (OSPS, Fleet® Phospho®-Soda, C.B. Fleet). Data reported to InKine indicate that this patient had at least three important risk factors for the development of acute renal failure (ARF) and nephrocalcinosis.

First, the patient had a history of renal insufficiency with a rising creatinine (1.7 mg/dl) and had been on meloxicam (Mobic®, Boehringer Ingelheim) for years. This was discontinued just prior to colonoscopy, but was restarted within 1 month for shoulder pain. Visicol® should be used with caution in patients with impaired renal function since they may have difficulty excreting large phosphate loads. It should be noted that the post-colonoscopy creatinine level was much smaller in this patient (2.6 mg/dl 2 months post-colonoscopy) than in the patients receiving OSPS (mean of 4.9 mg/dl 3 days to 2 months post-colonoscopy). It is unknown how much the meloxicam may have contributed to the rising creatinine. In January 2005, the patient's creatinine was 2.2 mg/dl.