Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2020; 8(12): 2585-2589
Published online Jun 26, 2020. doi: 10.12998/wjcc.v8.i12.2585
Biopsy-proven acute phosphate nephropathy: A case report
Kristianne Rachel Palanca Medina-Liabres, Bo Mi Kim, Sejoong Kim
Kristianne Rachel Palanca Medina-Liabres, Bo Mi Kim, Sejoong Kim, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Gyeonggi-do, South Korea
Author contributions: Medina-Liabres KRP wrote the manuscript and did literature review; Kim BM and Kim S were involved in patient’s medical care; Kim BM contributed to manuscript drafting; Medina-Liabres KRP and Kim BM collected patient’s clinical data; Kim S reviewed and edited the manuscript; Medina-Liabres KRP and Kim S were responsible for the revision of the manuscript; all authors have approved the final version for submission.
Informed consent statement: The patient gave informed written consent to renal biopsy and renal replacement therapy during treatment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sejoong Kim, MD, PhD, Professor, Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si 13620, Gyeonggi-do, South Korea. sejoong2@snu.ac.kr
Received: March 26, 2020
Peer-review started: March 26, 2020
First decision: April 29, 2020
Revised: May 27, 2020
Accepted: May 30, 2020
Article in press: May 30, 2020
Published online: June 26, 2020
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Hyperphosphatemia, Nephrocalcinosis, Acute phosphate nephropathy, Renal insufficiency, Chronic kidney disease, Biopsy, Case report

Core tip: The classic case of acute phosphate nephropathy (APN) is caused by oral sodium phosphate for bowel cleansing preparations. In this case report, we present a rare incident of biopsy-proven APN caused by excessive dietary phosphate intake in a 39-year-old diabetic male. APN was diagnosed by history of increased dietary phosphorus intake, clinical presentation of acute kidney injury, laboratory findings of hyperphosphatemia and elevated calcium phosphate product, and kidney biopsy findings, which showed tubular crystals positive for Von Kossa stain. This case highlights the importance of good history taking and kidney biopsy for the diagnosis of APN.