Factors related to renal dysfunction in patients with anorexia nervosa

Takakura, Satoshi; Nozaki, Tomoyoshi; Nomura, Yoshio; Koreeda, Chizu; Urabe, Harukuni; Kawai, Keisuke; Takii, Michiaki; Kubo, Chiharu

doi:10.1007/bf03327754

Cited by 25 publications

(24 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are various physical complications due to malnutrition and purging behavior (Westmoreland, Krantz, & Mehler, 2016). Renal failure, for example, is caused by dehydration and hypokalemia owing to self-induced vomiting and use of laxatives or diuretic drugs in addition to an insufficient intake of water (Takakura et al, 2006;Westmoreland et al, 2016). Liver transaminase levels elevate to different extents.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, hypoperfusion due to the dehydration causes renal dysfunction and hepatic disorder (Ma et al, 2015;Takakura et al, 2006). Hypoalbuminemia due to malnutrition, laxative use, and emesis cause endovascular dehydration.…”

Section: Casementioning

confidence: 99%

“…Hypoalbuminemia due to malnutrition, laxative use, and emesis cause endovascular dehydration. Moreover, renal parenchymal failure owing to hypokalemia based on insufficient intake of potassium, laxative use, and emesis occurs concomitantly with prerenal failure because of dehydration (Takakura et al, 2006). Malnutrition also leads to liver damage (Narayanan et al, 2010).…”

Section: Casementioning

confidence: 99%

See 2 more Smart Citations

Portal hypertension in prolonged anorexia nervosa with laxative abuse: A case report of three patients

Koga

Toda

Tatsushima

et al. 2019

Intl J Eating Disorders

View full text Add to dashboard Cite

Objective There has been no report on portal hypertension related to anorexia nervosa (AN). Method We describe three cases of portal hypertension manifesting with collateral circulation represented by gastroesophageal varices in prolonged AN with laxative abuse and self‐vomiting. These women, in their 20s to 50s, were diagnosed as having AN binging and purging type (AN‐BP) that included self‐induced vomiting and abuse of irritating laxatives (more than 100 tablets daily). Results Case 1 showed prominent ascites and a gastro‐renal shunt on computed tomography scanning. Case 2 showed gastroesophageal varices on endoscopic examination. Case 3 showed gastroesophageal varices on computed tomography scanning and endoscopic examination. We performed liver biopsies in all patients and found only slight pericellular fibrosis. Our patients showed typical symptoms of portal hypertension, although liver cirrhosis was not present. Discussion We speculated that abnormal eating and purging behaviors were involved in the development of portal hypertension. We hypothesized that long‐term laxative abuse, dehydration, and abnormal eating behavior are involved in the development of portal hypertension, considering these were common features in our patients. Portal hypertension and gastroesophageal varices should be considered as one of the potentially existing complications in prolonged AN‐BP with self‐induced vomiting and abuse of irritating laxatives.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Casementioning

confidence: 99%

Section: Casementioning

confidence: 99%

See 1 more Smart Citation

Portal hypertension in prolonged anorexia nervosa with laxative abuse: A case report of three patients

Koga

Toda

Tatsushima

et al. 2019

Intl J Eating Disorders

View full text Add to dashboard Cite

show abstract

“…CKD has also been reported in these patients, which are assumed to have been induced by chronic hypokalemia following tubulointerstitial damage or potential metabolic and hemodynamic effects [3,10]. Duration of illness and abuse of diuretics or laxatives have been reported as risk factors of CKD and the decline of the glomerular filtration rate (GFR) [11]. Nephrolithiasis or nephrocalcinosis accompanied by CKD have been reported in these patients [12,13].…”

Section: Discussionmentioning

confidence: 99%

Two cases of eating disorder revealed by the breakout of acute kidney injury after angiotensin II receptor blocker administration

Kaneko

Tsukamoto

2013

CEN Case Rep

View full text Add to dashboard Cite

Case 1: A 39-year-old woman with schizophrenia, obesity, hypertension and dyslipidemia was admitted to our hospital for deteriorating serum Cr level, from 97.2 to 645.3 lmol/l. She had been started on losartan 5 months earlier. After suspension of losartan and infusion of saline, her serum Cr level gradually recovered and she was discharged. Unfortunately, her physician restarted her on losartan, and 5 months after this discharge, her serum Cr level rose again to 194.5 lmol/l; again, serum Cr promptly recovered when losartan was discontinued. Selfinduced vomiting after overeating, suggesting bulimia nervosa, was revealed via the detection of a remarkable reduction of chloride compared to sodium in her spot-urine sample. Case 2: A 39-year-old woman who had been diagnosed with bipolar disorder and diabetes mellitus was admitted to our hospital with suspected diabetic ketoacidosis. After improvement in her blood sugar level, olmesartan administration for hypertension was begun. Four days later, her serum Cr level had risen from 60.1 to 256.4 lmol/l. After suspension of olmesartan and infusion of saline, her serum Cr level gradually fell to normal levels. Urinalysis revealed the dissociation of sodium and chloride. During her hospitalization, habitual self-induced vomiting was discovered. The measurement of urinary electrolytes may be useful for the detection of eating disorders with self-induced vomiting; in these patients, the administration of angiotensin II receptor blockers may induce acute kidney injury.

show abstract

“…Renal inflammation has been associated with the use of laxatives, 93 and longer duration of laxative abuse is negatively associated with poorer creatinine clearance (a measure of kidney functioning) in individuals with anorexia nervosa. 94 Individuals with analgesic nephropathy (kidney damage due to use of analgesic medications like aspirin) are more likely to have a history of laxative abuse, suggesting that laxative abuse may increase vulnerability to other medical conditions. 95 Concerning diuretic abuse, tubulointerstitital nephritis (swelling of the kidney tubules) has been associated with abuse of the diuretic furosemide.…”

Section: Kidneymentioning

confidence: 99%

The medical complications associated with purging

Forney

Buchman‐Schmitt

Keel

et al. 2016

Intl J Eating Disorders

105

View full text Add to dashboard Cite

Objective Purging behaviors, including self-induced vomiting, laxative abuse, and diuretic abuse, are present across many of the eating disorders. Here we review the major medical complications of these behaviors. Method Although we identified over 100 scholarly articles describing medical complications associated with purging, most papers involved case studies or small, uncontrolled samples. Given the limited evidence base, we conducted a qualitative (rather than systematic) review to identify medical complications that have been attributed to purging behaviors. Results Medical conditions affecting the teeth, esophagus, gastrointestinal system, kidneys, skin, cardiovascular system, and musculoskeletal system were identified, with self-induced vomiting causing the most medical complications. Conclusions Purging behavior can be associated with severe medical complications across all body systems. Mental health professionals should refer patients with purging behaviors to medical providers for screening and treatment as needed. The medical work-up for individuals with eating disorders should include a comprehensive metabolic panel, complete blood count, and a full body exam including the teeth to prevent severe complications. Medical providers should screen patients for purging behaviors and associated medical complications, even in the absence of an eating disorder diagnosis, to increase the detection of eating disorders. Recognizing the link between purging and medical complications can aid in identifying potential eating disorders, particularly those that often elude detection such as purging disorder.

show abstract

Factors related to renal dysfunction in patients with anorexia nervosa

Abstract: Renal function should be carefully followed during the treatment of AN patients with a long duration of illness, especially those with long-term laxative abuse.

Cited by 25 publications

References 13 publications

Portal hypertension in prolonged anorexia nervosa with laxative abuse: A case report of three patients

Portal hypertension in prolonged anorexia nervosa with laxative abuse: A case report of three patients

Two cases of eating disorder revealed by the breakout of acute kidney injury after angiotensin II receptor blocker administration

The medical complications associated with purging

Contact Info

Product

Resources

About