Renal cortical necrosis following a colonoscopy
Muhammad Hammadah1, Lillian Gaber, Rajeev Raghavan
1Department of Medicine, University of Aleppo, Aleppo, Syria.
Clinical Nephrology
|August 24, 2012
Summary
Polyethylene glycol (PEG) bowel preparation may cause acute kidney injury (AKI), specifically renal cortical necrosis (RCN). This case highlights a potential link between PEG, its metabolite diethylene glycol (DEG), and severe kidney damage, necessitating further investigation.
Area of Science:
- Nephrology
- Gastroenterology
- Toxicology
Background:
- Screening colonoscopies commonly utilize polyethylene glycol (PEG) for bowel preparation.
- Acute kidney injury (AKI) is a potential complication, though the precise mechanisms remain unclear.
- Diethylene glycol (DEG), a metabolite of PEG, is a known nephrotoxin.
Observation:
- A 76-year-old African-American male developed acute renal cortical necrosis (RCN) two weeks post-colonoscopy.
- The patient's sole bowel preparation agent was PEG.
- Elevated lactate dehydrogenase (LDH) and biopsy confirmed RCN.
Findings:
- The case suggests a potential causal link between PEG bowel preparation and RCN.
- PEG biodegradation to nephrotoxic DEG may be the underlying mechanism.
- The patient required long-term hemodialysis.
Implications:
- Clinicians should consider PEG-induced nephrotoxicity in patients presenting with AKI after colonoscopy.
- Further research is warranted to elucidate the exact mechanisms of PEG-associated AKI.
- Enhanced vigilance and alternative bowel preparation strategies may be necessary for high-risk patients.
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