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Julian L. Seifter, MD; Andrew P. Fuller, BA

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In a large retrospective study, Khurana and colleagues¹ report that oral sodium phosphate solution preparation is associated with a decline in glomerular filtration rate in elderly patients relative to controls following colonoscopy. Glomerular filtration rate was estimated based on serum creatinine levels. Recommendations were made to limit the use of oral sodium phosphate solution in patients undergoing colonoscopy because of a concern for decreased renal function in at-risk patients.

We propose that methods of glomerular filtration rate calculation based on values for serum creatinine overlook the potential impact of cleansing preparations on bowel flora involved in extrarenal creatinine clearance. Creatinine is normally secreted into the digestive tract. However, bacteria expressing creatininase enzymes may metabolize this secreted creatinine, resulting in an extrarenal "clearance." Such bacteria have been shown to be induced significantly in patients with advanced chronic renal failure (CRF) due to small . . . [Full Text of this Article]

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