Pathology of Resin-Induced Gastrointestinal Damage: Report of 15 Cases and Review of Literature

Abstract

Objective: Medication resins such as Kayexalate and Sevelamer used in the setting of chronic kidney disease for the correction of hyperkalemiaand hyperphosphatemia are associated with gastrointestinal mucosal injury. In this study we describe the clinico-pathological features ofResin-induced gastrointestinal mucosal injury highlighting the histo-morphological appearances and differential diagnoses. The aim of thisstudy is to increase the awareness of pathologists and clinicians alike to an under-reported etiology and pattern of intestinal mucosal injuryrelated to medical resin therapy which may at times pose a clinical emergency.Material and Method: The archives of the Department of Histopathology, Mubarak Al Kabir hospital were analyzed for cases of resin-inducedgastrointestinal mucosal injury between 2013 and 2018.Results: Of the 15 cases, Kayexalate crystals were identified in 7 cases, Sevelamer in 5 cases and both together were seen in 3 cases. Resin crystalswere identified in the gastric antrum&duodenum (3 cases), colon (9 cases in the left colon, 2 cases in the right colon) and anal canal (1 case).The histological tissue reactions included mucosal necrosis (1 case), inflammatory polyps (2 cases), mucosal ulcerations with granulation tissueformation (10 cases), perforation (1 case) , and luminal crystals (1 case).Conclusion: Accurate and timely recognition of the resin crystals in biopsy samples with clinical correlation is mandatory to avoid seriouscomplications.