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Kidney Week

Abstract: TH-PO170

The Binder That Got Us in a Bind, Sevelamer Crystal Associated Bowel Necrosis: A Case Report

Session Information

  • CKD-MBD: Targets and Outcomes
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Hryzak, Sarah, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Janakiraman, Arun, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Kobrin, Sidney M., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Geara, Abdallah Sassine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Aggarwal, Sandeep, University of Pennsylvania, Philadelphia, Pennsylvania, United States
Introduction

Crystal associated colonic necrosis is a rare iatrogenic complication most reported with kayexalate/sorbitol complex use. Sevelamer is a commonly prescribed and well tolerated phosphate binder used in patient's with advanced chronic kidney disease (CKD) for hyperphosphatemia. We report a case of biopsy proven colonic necrosis associated with sevelamer crystals.

Case Description

A 67-year-old male with history of IgA nephropathy now end stage renal disease (ESRD) status post failed cadaveric kidney transplant, atrial fibrillation, AAA s/p endovascular repair admitted with abdominal pain, nausea and vomiting found to be in septic shock. Imaging revealed pneumoperitoneum and sigmoid colon perforation. Work up for bowel perforation included evaluation of cardiac/embolic source with transthoracic echocardiogram with no intracardiac thrombi/vegetations. Abdominal vascular imaging showed intact AAA endograft without any endoleaks, dissection or mural thrombi. Work up for infectious, hypercoagulable and autoimmune causes for colitis were unrevealing. Patient underwent exploratory laparotomy with left hemi-colectomy. Anatomical pathology revealed crystalline resin within lumen and stoma ulceration (figure 1) compatible with sevelamer crystals, no evidence of viral inclusions and viable proximal resection margins.

Discussion

Colonic necrosis is more commonly known to be associated with various etiologies including cardio-embolic sources, underlying vascular disease, infectious processes and autoimmune conditions. Crystal associated colonic necrosis is a rarely reported cause. Our case report reveals a possible association between sevelamer administration and colonic injury. Large scale correlation studies need to be done to further explore the clinical pathological relationship between sevelamer and colonic necrosis.

Figure 1. Colonic mucosal ulceration with an associated sevelamer crystal