Precipitation of phosphate crystals in the kidney can result in renal impairment.


Clinical features:

(1) acute onset of renal impairment with increase in serum creatinine (usually >= 50% above baseline)

(2) history of hyperphosphatemia or phosphate load (often an oral sodium phosphate preparation prior to colonoscopy)

(3) no history of hypercalcemia

(4) exclusion of other explanations for renal impairment


Pathologic features in a kidney biopsy:

(1) deposition of calcium phosphate crystals in the distal renal tubules and collecting ducts

(2) tubular atrophy and interstitial fibrosis


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