A Case of Anorexia Nervosa with Acute Renal Failure Induced by Rhabdomyolysis; Possible Involvement of Hypophosphatemia or Phosphate Depletion.

Abstract

A 16-year-old girl with anorexia nervosa first presented with malnutrition, liver dys function, and rhabdomyolysis. Administration of fluid and nutrition saved her from the initial critical state, but acute renal failure followed. Laboratory examination revealed intrinsic renal failure induced by rhabdomyolysis. Latent phosphate depletion and refeeding-induced hypo phosphatemia was implicated as the cause of rhabdomyolysis; however coexisting hypotension, dehydration, and liver dysfunction may have contributed to the renal failure. The patient recovered from azotemia by hemodialysis. This is the first reported case of anorexia nervosa with acute renal failure resulting from rhabdomyolysis induced by hypophosphatemia or phosphate depletion. (Internal Medicine 31: 478-482, 1992)

Renal Involvement in Psychological Eating Disorders

“…Hypokalemia is a known cause of rhabdomyolysis. There are some case reports of rhabdomyolysis in AN with [12] or without [13] acute renal failure. We suppose that dietary restriction and starvation, severe energetic deficit, chronic dehydration and metabolic derangement, especially hypophosphatemia and/or phosphate depletion, may induce chronic subclinical release of tissue catabolism products (CK, aldolase, AST, ALT, LDH, myoglobin) and chronic kidney injury.…”

Increased creatinine kinase and rhabdomyolysis in anorexia nervosa

“…Nevertheless, only a few cases of anorexia nervosa with lifethreatening states, caused by rhabdomyolysis and accompanying renal failure are reported in the literature. [6][7][8][9] In two cases, hypophosphatemia and phosphate depletion seemed to be responsible for the observed rhabdomyolysis and for dangerous complications such as renal failure. 6,7 It is well known, that during phases of refeeding, the risk for refeeding-induced hypophosphatemia and rhabdomyolysis is increased.…”

“…[6][7][8][9] In two cases, hypophosphatemia and phosphate depletion seemed to be responsible for the observed rhabdomyolysis and for dangerous complications such as renal failure. 6,7 It is well known, that during phases of refeeding, the risk for refeeding-induced hypophosphatemia and rhabdomyolysis is increased. In one case of anorexia nervosa, a hypokalemic rhabdomyolysis was worsened by vomiting which contributed to the disturbance of the electrolyte balance.…”

“…[6][7][8][9] These patients often experience renal disturbances with hypovolemia, hyperthermia, or electrolyte abnormalities 6 which lead to severe clinical symptoms and to an increased risk to develop renal failure.…”

Acute liver damage and subsequent hypophosphatemia in malnourished patients: Case reports and review of literature

“…In particular, hypophosphatemia is considered to have an important role in refeeding-induced lethal conditions such as cardiac arrest, respiratory failure, or acute renal failure due to rhabdomyolysis. [7][8][9] Although serum phosphate concentrations usually can be maintained within normal limits in severely malnourished patients by increased renal tubular reabsorption, the total body phosphorus pool is actually depleted. 10 In such a condition, glucose intake and the subsequent release of insulin precipitates the rapid shift of phosphate from the extracellular to intracellular environment, resulting in severe hypophosphatemia.…”