Abstract
This study describes ion exchange resin-induced colitis occurring in a 63-year-old female undergoing regular hemodialysis (HD) for 5 years. Because of inadequate food intake, she presented with hyperkalemia and hyperphosphatemia, and was administered calcium polystyrene sulphonate (PS-Ca), calcium carbonate, colestimid (Col), along with several purgatives for severe constipation. On January 2004 anemia and fecal occult blood appeared. Colonofiberscopy (CF) demonstrated several diverticula of the ascending colon and she was diagnosed as having hemorrhagic colitis. She soon recovered after meals were stopped for a week and a blood transfusion. However, anemia and fecal occult blood re-appeared in April, despite continuation of erythropoietin-beta 9,000U/week administration. Gastrofiberscopy examination in April showed only mild superficial gastritis. Treatment against gastritis could not improve anemia and fecal occult blood remained positive. CF examined in June found several erosions and ulcers scattered on the crescent fold of the right-sided transverse colon. Careful investigation of the biopsy specimen showed that 2 different polygonal crystalline materials co-existed with inflammatory cells in the mucous membrane near the crypt. Several stains such as Hematoxylin Eosin, Congo Red, Direct Schiff, and PAS disclosed PS-Ca and Col. Thus, the final histological diagnosis was chronic mucosal injury and ulcer formation due to crystalline materials. Ion exchanger resins such as PS-Ca and Col are often used to manage hyperkalemia, hyperphosphatemia, and hyperlipidemia in HD patients. However, information about adverse effects such as colonic ulcer, necrosis, and perforation of colon are limited among the HD unit staff. These phenomena are thought to occur frequently in constipated patients.
