Intravenous iron-induced hypophosphatemia and kidney stone disease

Bone Reports, vol. 21, pp. 101759

Abstract

Patients with Crohn's disease are at increased risk for symptomatic nephrolithiasis. Stones in these patients are most commonly composed of calcium oxalate monohydrate or mixed calcium-oxalate and calcium-phosphate. Precipitation of both minerals depends on urinary pH, calcium, phosphate and oxalate excretion. The present manuscript reports on two patients with Crohn's disease and bowel resection, in whom the onset of symptomatic urolithiasis occurred after repeated infusions of ferric carboxymaltose - a drug, which is known to cause hyperphosphaturia. The present study shows that ferric carboxymaltose-induced hyperphosphaturia can be associated with kidney stone formation and symptomatic urolithiasis, especially in patients treated with calcitriol. Calcitriol has been shown to mitigate ferric carboxymaltose-induced secondary hyperparathyroidism and hyperphosphaturia, but is known to increase urinary calcium excretion. Chemical analysis of recovered stones revealed that they were mixed calcium oxalate and phosphate stones. Ring-like deposition of iron detected by spatially resolved elemental analysis using laser ablation-inductively coupled plasma mass spectrometry, showed that the stones also contained iron. Based on our findings, we propose that patients with inflammatory bowel disease requiring intravenous iron therapy should be carefully monitored for the development of hypophosphatemia and urolithiasis. If hypophosphatemia occurs in such patients, calcitriol should be used with caution.

Authors 17

1. Marlene Panzer
   Affiliation as printed

   Christian Doppler Laboratory for Iron and Phosphate Biology, Austria

   Department of Internal Medicine I, Austria

2. Eva Meindl
   Affiliation as printed

   Christian Doppler Laboratory for Iron and Phosphate Biology, Austria

   Department of Internal Medicine I, Austria

3. Benedikt Schaefer
   Affiliation as printed

   Department of Internal Medicine I, Austria

4. Sonja Wagner
   Affiliation as printed

   Christian Doppler Laboratory for Iron and Phosphate Biology, Austria

   Department of Internal Medicine I, Austria

5. Bernhard Glodny
   Affiliation as printed

   Department of Radiology, Austria

6. Gert J. Mayer
   Affiliation as printed

   Department of Medicine IV, Austria

7. Andreas Pircher

   Universität Innsbruck

   Affiliation as printed

   Department of Internal Medicine V, Anichstrasse 35, 6020 Innsbruck, Austria

8. Christoph C. Schwarz
   Affiliation as printed

   Department of Medicine 1, Pyhrn-Eisenwurzen Klinikum Steyr, Sierninger Str. 170, 4400 Steyr, Austria

9. Felix Beckmann

   Helmholtz-Zentrum Hereon

   Affiliation as printed

   Institute of Materials Physics, Helmholtz-Zentrum Hereon, Max-Planck-Str. 1, 21502 Geesthacht, Germany

10. Clivia Hejny

    Universität Innsbruck

    Affiliation as printed

    Institute of Mineralogy and Petrography, Faculty of Geo- and Atmospheric Sciences, University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria

11. Bastian Joachim

    Universität Innsbruck

    Affiliation as printed

    Institute of Mineralogy and Petrography, Faculty of Geo- and Atmospheric Sciences, University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria

12. Juergen Konzett

    Universität Innsbruck

    Affiliation as printed

    Institute of Mineralogy and Petrography, Faculty of Geo- and Atmospheric Sciences, University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria

13. Herbert Tilg
    Affiliation as printed

    Department of Internal Medicine I, Austria

14. Isabel Maria Heidegger

    Innsbruck Medical University · Universität Innsbruck

    Affiliation as printed

    Department of Urology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria

15. Myles Selig Wolf

    Duke Medical Center · Duke University

    Affiliation as printed

    Division of Nephrology, Department of Medicine, Duke University School of Medicine and Duke Clinical Research Institute, 40 Duke Medicine Cir Durham, NC 27710-4000, United States of America

16. Ralf Weiskirchen Aachen Institute of Molecular Pathobiochemistry Experimental Gene Therapy and Clinical Chemistry (IFMPEGKC)

    RWTH Aachen University · Universitätsklinikum Aachen

    Affiliation as printed

    Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry (IFMPEGKC), RWTH University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany

17. Heinz Zoller corresponding
    Affiliation as printed

    Christian Doppler Laboratory for Iron and Phosphate Biology, Austria

    Department of Internal Medicine I, Austria