Sevelamer Carbonate Crystal-Induced Colitis.

Area of Science:

• Nephrology
• Gastroenterology
• Pathology

Background:

• Hyperphosphatemia is a common complication in end-stage renal disease (ESRD).
• Phosphate binders like sevelamer carbonate are crucial for managing secondary hyperparathyroidism in ESRD patients.
• Dietary constraints alone are often insufficient to control phosphate levels.

Observation:

• A 47-year-old male with diabetes and ESRD presented with abdominal pain and nausea.
• CT scans revealed circumferential colonic lesions, raising concerns for ischemia or inflammatory bowel disease.
• Colonoscopy showed nearly obstructing lesions, and pathology confirmed crystalline material consistent with sevelamer carbonate.

Findings:

• Sevelamer carbonate was identified as the cause of colitis in this ESRD patient.
• Discontinuation of sevelamer carbonate led to symptom resolution.
• The patient transitioned to calcium carbonate with improved outcomes.

Implications:

• Clinicians should consider sevelamer carbonate-induced colitis in ESRD patients with gastrointestinal complaints.
• Increased awareness of this underreported adverse effect is crucial for appropriate patient management.
• This case highlights the importance of considering medication side effects in complex patient cases.