Acute phosphate nephropathy

Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USACASE PRESENTATIONA 60-year-old white Latino female with a clinical diagnosisof diabetes mellitus (diagnosed in 1993) and hypertensionwas referred to the chronic kidney disease clinic atBrigham and Women’s Hospital for the evaluation of acutekidney injury; serum creatinine had increased from abaseline of 0.9 to 1.5mg/dl in a 11-week period. She wasasymptomatic at the time of presentation. Her pastmedical history included a total abdominal hysterectomywith bilateral salpingo oophorectomy and uppervaginectomy for high-grade squamous intraepitheliallesion of the cervix, 11 weeks prior to presentation. Threeweeks prior to presentation (8 weeks after surgery) andwithin a week of each other, she was evaluated for twoconsecutive episodes of acute onset of chest pain withpulmonary edema in the setting of severe hypertension.Both episodes had blood pressures in excess of190–200mmHg systolic that resolved with intravenousdiuretics. Cardiovascular workup revealed no evidence ofischemic heart disease. Additionally, renal evaluationincluded magnetic resonance angiography with andwithout gadolinium, which did not reveal renal arterystenosis. However, serum creatinine peaked at 1.9 mg/dlimmediately after surgical procedure and remainedelevated at 1.5mg/dl throughout the course of her currentpresentation (corresponding to a glomerular filtration rateof 33ml/min per 1.73m