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Acute phosphate nephropathy — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesAcute phosphate nephropathySCE Acute Medicine

A patient with CKD develops non-recovering AKI after oral sodium-phosphate bowel preparation. Calcium is low-normal and renal biopsy shows tubular calcium-phosphate deposits. What is the diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Acute phosphate nephropathy after bowel preparation

The best answer is “Acute phosphate nephropathy after bowel preparation”. This is correct because a large phosphate load can cause calcium-phosphate precipitation in distal tubules, particularly with CKD, older age, volume depletion or renin–angiotensin blockade. The exposure and biopsy distinguish it from urate, oxalate, light-chain and cholesterol-crystal renal injuries.

Reference: NICE NG148 acute-kidney-injury recommendations: https://www.nice.org.uk/guidance/ng148/chapter/Recommendations