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Sodium phosphate is used widely for bowel preparation before colonoscopy. Traditional contraindications include renal insufficiency, congestive heart failure, and decompensated liver disease. Recently, more than 20 cases of acute phosphate nephropathy were reported after use of sodium phosphate for bowel preparation for colonoscopy (review: Ann Pharmacother 2007; 41:1466). Most of these patients did not have the traditional contraindications; about 80% were women, and about two thirds had preexisting hypertension. Renal biopsy showed calcium phosphate crystal deposition in the renal tubules. The reporting of this adverse effect has led to a decline in the use of sodium phosphate, as well as tremendous concern within the gastroenterology com…