Kidney Disease Associated With Anorexia Nervosa: A Case Series With Kidney Biopsies

Abstract

Rationale & Objective Anorexia nervosa is often intractable and induces various physical disorders, including kidney disease and mineral disorders, occasionally progressing to kidney failure. No consensus-based clinical practice guidelines have been established for patients with anorexia nervosa referred to a nephrologist. Study Design Patients with anorexia nervosa–associated kidney disease diagnosed were analyzed retrospectively. Kidney outcomes were defined as doubling of serum creatinine level and/or progression to end-stage kidney disease. Setting & Participants Patients with a history of anorexia nervosa with kidney disease, including electrolyte abnormalities, who were referred to our hospital between 1992 and 2017 were included. Results 14 female patients were included. The time from anorexia nervosa onset to the initial visit with a nephrologist was 17.8 years. At the first visit, median body mass index was 13.4 kg/m 2 , median serum creatinine level was 1.9 mg/dL, and median serum potassium level was 2.7 mmol/L. All patients showed hypokalemia and addictive vomiting or diuretic/laxative abuse. During the median observation period of 3.1 years, kidney outcomes occurred in 9 patients, and 2 died due to their anorexia nervosa. 4 patients underwent kidney biopsy. The kidney biopsy findings of these patients included hypertrophy of the juxtaglomerular apparatus, advanced glomerular collapse, and interstitial fibrosis, consistent with ischemic kidney injury and hypokalemic nephropathy. Limitations The sample size was small, and kidney function was assessed based on serum creatinine levels in patients with anorexia nervosa with low muscle mass. Conclusions Most patients with anorexia nervosa referred to nephrologists had kidney disease at the time of the first visit. Improving kidney outcomes of patients with anorexia nervosa may require earlier collaboration between psychiatrists and nephrologists.

Incidence of Impaired Kidney Function Among Adolescent Patients Hospitalized With Anorexia Nervosa

“…Kidney histologic findings revealed hypertrophy of the juxtaglomerular apparatus, advanced glomerular collapse, and interstitial fibrosis, consistent with ischemic kidney injury. 6 In another AN cohort, 7 end-stage kidney disease was reported in 5.2% of the patients. However, these studies provide data on adults with long-standing (>20 years) AN.…”

“…There was no difference in admission BMI between anorexia groups with and without kidney function impairment. Mean (SD) free T 3 levels (3.5 [0.2] pmol/L vs 4.08 [1.2] pmol/L; P < .001) and mean (SD) minimal heart rate (44 [11] beats per min vs 56 [16] beats per min; P < .001) were lower and hospital stay was longer (median, 13 [IQR,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) days vs 8 [IQR,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] days; P = .03) in the impaired kidney function group. The highest correlation was found between minimal heart rate and minimal eGFR (R = 0.53; P < .001).…”

Renal and electrolyte complications in eating disorders: a comprehensive review

“…Dialysis has significant effects on quality of life, and patients on dialysis have lower life expectancy, primarily due to increased risk of cardiovascular disease and infection [ 14 ]. The rate of dialysis in patients with AN is unknown, though there are case series and case reports of patients with AN who developed ESRD and underwent dialysis, including one patient with longstanding AN-BP who began peritoneal dialysis with subsequent death from sepsis [ 15 , 16 ].…”

“…Patients in whom kidney disease is found should be referred to a nephrologist (kidney specialist) for further management which may include renal biopsy to rule out kidney disease from other causes. Furthermore, such patients should be educated regarding the risks of purging behaviors [ 16 ]. One case series of 14 patients with a greater than 15 year history of AN-BP already had relatively severe and irreversible kidney disease by the time of their initial evaluation by a nephrologist [ 16 ].…”

“…Furthermore, such patients should be educated regarding the risks of purging behaviors [ 16 ]. One case series of 14 patients with a greater than 15 year history of AN-BP already had relatively severe and irreversible kidney disease by the time of their initial evaluation by a nephrologist [ 16 ]. Early diagnosis and intervention are important given low eGFR is a risk factor for CKD and eventual ESRD [ 17 ].…”