How the treatment of gastrointestinal tract disorders may be infl uenced by the kidneys

Summary: The treatment of gastrointestinal tract (GIT) diseases may, under specific conditions, be significantly influenced by the kidneys or by kidney disorders. One of the potential scenarios of such interaction is the concurrent involvement of the kidneys and the GIT organs within one disorder, another option being the negative impact of impaired renal function on the prognosis of the GIT disease and, finally, the need for an adequate choice and dose adjustment of renally eliminated medication to avoid nephrotoxicity. Renal impairment may occur as an adverse effect of the treatment of the GIT condition and may limit further therapy. In this context we have recently focused on the following clinical situations: the development of acute kidney injury during treatment with proton pump inhibitors, renal complications of inflammatory bowel disease management and the development of acute phosphate nephropathy due to the use phosphate containing laxatives. An early identification of the mechanisms leading to renal injury can prevent the development of irreversible renal lesions and facilitate an efficient treatment of the GIT. Key words: treatment of gastrointestinal tract disorders – acute kidney injury – proton pump inhibitors – renal complications of inflammatory bowel disease – acute phosphate nephropathy

An unnoticed reason of renal failure: Acute phosphate nephropathy

Acute Phosphate Nephropathy is a clinical and pathological finding characterized by acute and subsequent chronic renal failure following the use of intestinal cleansers containing sodium phosphate. The pathophysiology of Acute Phosphate Nephropathy occurs due to the increase of sodium and water absorption in the proximal tubules due to hypovolemia, and the accumulation of calcium phosphate load in the distal tubules in the collector and distal canals. Renal biopsy findings include acute and chronic tubular damage with tubular and interstitial calcium phosphate deposits. Prevention of Acute Phosphate Nephropathy can be achieved by hydration before and after the use of calcium phosphate in risky patients, minimizing the sodium phosphate dose, and having 12-hour intervals between sodium phosphate applications. In this article, we aimed to present the patients who used sodium phosphate for colonoscopy and developed Acute Phosphate Nephropathy.

Prevention of acute kidney injury

This chapter discusses commonly used drugs that frequently are associated with nephrotoxic acute kidney injury (AKI). These drugs include aminoglycosides; old and new formulations of amphotericin B; a number of drug-related crystal-induced AKI, including acute phosphate nephropathy; and methotrexate nephropathy. This chapter also includes a discussion of tumour lysis syndrome and some reflections on the prevention of AKI in tropical countries.