Calcium Polystyrene Sulfonate Induced Colonic Necrosis in Patient with Chronic Kidney Disease

Sung Hoa Lee; Sung Jung Kim; Go Eun Kim; Woo Jin Lee; Won Ki Hong; Gwang Ho Baik; Young Hee Choi; Dong Joon Kim

doi:10.4166/kjg.2010.55.4.261

Journal List > Korean J Gastroenterol > v.55(4) > 1006657

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Lee, Kim, Kim, Lee, Hong, Baik, Choi, and Kim: Calcium Polystyrene Sulfonate Induced Colonic Necrosis in Patient with Chronic Kidney Disease

Original Article

Korean J Gastroenterol 2010;55(4):261-265.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.55.4.261

Calcium Polystyrene Sulfonate Induced Colonic Necrosis in Patient with Chronic Kidney Disease

Sung Hoa Lee, M.D., Sung Jung Kim, M.D., Go Eun Kim, M.D., Woo Jin Lee, M.D., Won Ki Hong, M.D., Gwang Ho Baik, M.D., Young Hee Choi, M.D.^∗, Dong Joon Kim, M.D.

Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea

^∗Department of Pathology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea

Correspondence to: Sung Jung Kim, M.D. Department of Internal Medicine, Chuncheon Sacred Heart Hospital, 153, Gyo-dong, Chuncheon 200-704, Korea Tel: +82-33-240-5821, Fax: +82-33-241-8064 E-mail: ksjungdr@hallym.or.kr

Received 30 March 2009 Accepted 16 January 2010

Abstract

A 63-year-old woman was admitted due to right upper quadrant abdominal pain. She was going through hemodialysis due to end stage renal disease and taking calcium polystyrene sulfonate orally and rectally due to hyperkalemia. Colonoscopy showed a circular ulcerative mass on the proximal ascending colon. Biopsy specimen from the mass showed inflammation and necrotic debris. It also revealed basophilic angulated crystals which were adherent to the ulcer bed and normal mucosa. These crystals were morphologically consistent with calcium polystyrene sulfonate. She was diagnosed with calcium polystyrene phosphate induced colonic necrosis and improved with conservative treatment.

Keywords: Calcium polystyrene sulfonate, Colon, Necrosis, Hyperkalemia

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Fig. 1.

Colonoscopic findings. (A) A circular ulcerating mass in proximal ascending colon was noted, (B) Areas other than pathologic lesions did not show any abnormalities.

Fig. 2.

Microscopic findings. (A) Biopsy specimen of normal mucosa showed basophilic angulated crystals (arrow) (H&E stain, ×100). (B, C) Biopsy specimens of necrotic tissue also showed basophilic angulated crystals (arrows) (H&E, ×40, H&E, ×100).

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