Hypokalemic nephropathy after pelvic pouch procedure and protective loop ileostomy

Proctocolectomy with ileal pouch-anal anastomosis and temporary ileostomy h as been established as a curative operation in severe ulcerative colitis du ring the last 2 decades. Electrolyte imbalances during the first postoperat ive weeks until ileostomy closure have been reported previously. Here we re port about a 70-year-old male patient with a 38-year-history of severe ulce rative colitis who developed slowly progressive renal failure after proctoc olectomy with ileal pouch-anal anastomosis and temporary ileostomy. He was referred to our centre with a serum creatinine of 818 mu mol/L, hypokalemia of 2.83 mmol/L and metabolic alkalosis as a patient with suspected end-sta ge renal disease in order to perform shunt surgery and start chronic hemodi alysis. However, hypokalemia and metabolic alkalosis are not typical for en dstage renal disease, and renal biopsy showed typical signs of hypokalemic nephropathy. Our patient almost completely recovered after ileostomy closur e. This case clearly shows that temporary ileostomy in patients who underwent proctocolectomy, e.g. for ulcerative colitis, is associated with a risk of hypokalemic nephropathy. The appropriate and definite therapy is a surgical one, i.e. ileostomy closure. Monitoring metabolic changes after proctocole ctomy and ileostomy, especially during the defunctionalized stage when temp orary ileostomy is still present, is essential.