Sevelamer Crystals in the Gastrointestinal Tract (GIT)

• DOI: 10.1097/pas.0b013e3182999d8d
• Publication Date: 2013-09-21T13:50:15Z
• Authors: Benjamin J. Swanson; Berkeley N. Limke...; Ta-Chiang Liu; Elizabeth Montgomery; Kamran Nazari; Jason Y. Park; William C. Santan...; Michael S. Torbenson; Lysandra Voltaggio; Martha M. Yearsley; Christina A. Arnold
• Keywords: Sevelamer

We report the first description of sevelamer crystals (Renagel and Renvela, Genzyme; phosphate-lowering agents) in gastrointestinal tract. prospectively collected cases with novel, histologically identical from 4 major academic centers over a 1-year period studied pertinent clinicopathologic features. Sevelamer usage setting chronic kidney disease was demonstrated all (n=15 total cases, 7 patients). Sites involvement included esophagus (n=2), small bowel colon (n=11). The background mucosa normal only 1 case. Notable mucosal abnormality damage (n=5), acute inflammation (n=4), inflammatory polyp extensive ulceration ischemia (n=1), necrosis (n=1). In general, displayed broad, curved, irregularly spaced "fish scales" variably eosinophilic to rusty brown color on hematoxylin eosin (H&E) staining violet periodic acid-Schiff-alcian special diastase (PAS/D). To validate these findings, tablets (Renvela) were crushed submitted for histologic processing; findings those patient specimens. possibility Kayexalate (sodium polystyrene sulfonate) cholestyramine had been raised error. However, has narrow, rectangular is H&E magenta PAS/D; lacks internal scales," bright orange H&E, gray or hot pink PAS/D, unassociated injury. Further study required determine whether plays causal role injuries; however, its crystal an important mimic both choleystyramine. As history administration not documented any pathology requisition, awareness sevelamer's characteristic morphology crucial avoid diagnostic pitfalls mimics.