Gastroenterology
Volume 139, Issue 3 , Pages e8-e9, September 2010

Colonic Opacification in a Patient With End-Stage Kidney Disease

  • Ulrich Hofmann, MD

      Affiliations

    • Department of Internal Medicine I, University of Würzburg, University Clinic, Würzburg, Germany
    • ,
  • Meinrad Beer, MD

      Affiliations

    • Institute of Radiology, University of Würzburg, University Clinic, Würzburg, Germany

published online 06 August 2010.

Article Outline

 

Question: A 66-year-old woman with end-stage chronic kidney disease undergoing peritoneal dialysis for several years presented to the emergency department with diffuse abdominal pain. Physical examination revealed moderate diffuse abdominal tenderness. Routine laboratory evaluation revealed no seminal findings. Her medication consisted of aspirin, amlodipine, carvedilol, dihydralazine, lanthanum carbonate, l-thyroxine, simvastatin, erythropoietin, and torasemide. Microscopy of the peritoneal fluid excluded peritonitis. Abdomen radiography displayed gastric distention but did not reveal signs of free abdominal air (Figure A). Peculiarly, the radiograph showed radio-opaque material within the colon without former application of oral or rectal contrast agent.

What is the diagnosis?

See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

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Answer to the Clinical Challenges and Images in GI Question: Figure 4: Diffuse Opacifications Caused by Lanthanum Carbonate 

The radiograph shows diffuse opacifications throughout the colon caused by lanthanum carbonate. The latter is a novel compound prescribed for phosphate binding in patients with end-stage kidney disease. The drug is generally well tolerated. However, it causes gastrointestinal side effects, especially abdominal pain, which is a relatively common side effect, in up to 20% of patients.1

Lanthanum is a naturally occurring rare earth element that belongs to group 3 of the periodic table. For treatment of hyperphosphatemia, lanthanum is ingested as lanthanum salt. La3+ binds phosphate ionically across a wide pH range. Like barium sulphate, it strongly absorbs x-rays and therefore has contrast-agent like properties. One should bear in mind that lanthanum carbonate has an appearance similar to contrast agents and may confuse interpretation of x-ray based diagnostic procedures.2 Its radiopaque properties, which enable detection on conventional radiographs as well as on computed tomography, have even been suggested to serve as diagnostic approach to test drug compliance.3

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References 

  1. Mohammed IA, Hutchison AJ. Phosphate binding therapy in dialysis patients: focus on lanthanum carbonate. Ther Clin Risk Manag. 2008;4:887–893
  2. Cerny S, Kunzendorf U. Radiographic appearance of lanthanum. N Engl J Med. 2006;355:1160
  3. David S, Kirchhoff T, Haller H, et al. Heavy metal-rely on gut feelings: novel diagnostic approach to test drug compliance in patients with lanthanum intake. Nephrol Dial Transplant. 2007;22:2091–2092

 Conflicts of interest The authors disclose no conflicts.

 For submission instructions, please see the Gastroenterology web site (www.gastrojournal.org).

PII: S0016-5085(10)00015-6

doi:10.1053/j.gastro.2009.10.066

Gastroenterology
Volume 139, Issue 3 , Pages e8-e9, September 2010

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