Sevelamer-Induced Ischemic Enteritis

Area of Science:

• Nephrology
• Gastroenterology
• Pathology

Background:

• Hyperphosphatemia is a common complication in patients with renal impairment, increasing mortality risk.
• Sevelamer is a widely used phosphate binder to manage hyperphosphatemia.
• Gastrointestinal mucosal injury is a rare but documented adverse effect of sevelamer therapy.

Observation:

• A 35-year-old male patient with end-stage renal disease on peritoneal dialysis presented with abdominal pain and hematochezia.
• Initial diagnostic workup, including imaging and endoscopy, suggested ischemic enteritis.
• Histopathological examination revealed crystalloid structures with surrounding necrosis.

Findings:

• The crystalloid structures were identified as sevelamer crystals.
• The findings were consistent with sevelamer-induced ischemic enteritis.
• This case underscores a rare gastrointestinal complication of sevelamer treatment.

Implications:

• Clinicians should consider sevelamer crystal deposition as a potential cause of gastrointestinal injury in patients with renal impairment.
• Prompt recognition and diagnosis are crucial for managing sevelamer-induced enteritis.
• Further research may be warranted to elucidate the exact mechanisms and risk factors for this rare complication.