Non-uniform Progression of Chronic Tubulointerstitial Nephritis and Widespread Nephrocalcification in a Patient with Anorexia Nervosa

Hasegawa, Shin; Shibata, Maki; Mochizuki, Makoto; Katsuki, Takashi; Tada, Manami; Hinoshita, Fumihiko

doi:10.2169/internalmedicine.56.7594

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…However, if prolonged, it causes irreversible changes, such as interstitial fibrosis, tubular atrophy, and medullary cyst formation [ 10 ]. Tubulointerstitial nephritis has also been reported as a complication of persistent hypokalemia in patients with anorexia nervosa [ 4 , 11 , 12 ]. The mechanism of tubulointerstitial nephritis in hypokalemia has not been established; however, the production of monocyte chemotactic protein 1 (MCP-1), a mediator of macrophage infiltration, is reportedly increased in the kidneys of rats with hypokalemia.…”

Section: Discussionmentioning

confidence: 99%

Improvement in Tubulointerstitial Nephritis With Glucocorticoid Therapy in an Anorexia Nervosa Patient

Torigoe,

Yoshida,

Sakamoto

et al. 2023

J Med Cases

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Anorexia nervosa is a psychiatric disorder that is often diagnosed in adolescents and young adults. Renal-related complications of anorexia nervosa include abnormal water metabolism, electrolyte abnormalities, and nephrocalcinosis, which may lead to irreversible renal damage. Furthermore, tubulointerstitial nephritis has been reported as a renal pathological feature of anorexia nervosa. Immunosuppressive therapy, such as with glucocorticoids, has been recommended for idiopathic interstitial nephritis treatment; however, the effectiveness of immunosuppressive therapy for interstitial nephritis in patients with anorexia nervosa remains unestablished. Here, we report a case of interstitial nephritis in a patient with anorexia nervosa whose renal function was successfully improved with glucocorticoid therapy. The patient was a 38-year-old woman who was referred for renal dysfunction (estimated glomerular filtration rate: 7.6 mL/min/1.73 m 2 ). She had anorexia nervosa and repeated episodes of vomiting. Hypokalemia (K: 2.1 mEq/L) and metabolic alkalosis (HCO 3 - : 54.2 mEq/L) were observed. Fluid therapy and potassium supplementation did not improve renal function; therefore, a percutaneous renal biopsy was performed. The renal pathology results revealed interstitial fibrosis, inflammatory cell infiltration in the interstitium, and tubulitis, suggesting a diagnosis of tubulointerstitial nephritis. Glucocorticoid therapy improved the patient’s renal function to an estimated glomerular filtration rate of 19.91 mL/min/1.73 m 2 , and the renal function remained stable thereafter. This case suggests that glucocorticoid therapy may be considered for the treatment of interstitial nephritis in patients with anorexia.

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Section: Discussionmentioning

confidence: 99%

Improvement in Tubulointerstitial Nephritis With Glucocorticoid Therapy in an Anorexia Nervosa Patient

Torigoe,

Yoshida,

Sakamoto

et al. 2023

J Med Cases

View full text Add to dashboard Cite

show abstract

“…Chronic hypokalemia is assumed to cause tubulo-interstitial damage by ammonia-mediated complement activation (so-called hypokalemic nephropathy) (13). Furthermore, Hasegawa et al reported a patient with AN associated with tubulo-interstitial nephritis and hypokalemia who had biopsy-proven widespread calcification of the renal tubules (14). Although the exact pathophysiology is unclear, several other reports have also described cases of nephrocalcinosis among patients with AN (15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Deficiency-induced Osteomalacia in a Patient with Anorexia Nervosa

et al. 2021

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A 48-year-old woman with a 9-year-history of anorexia nervosa (AN) was admitted complaining of generalized bone pain. Blood tests showed hypocalcemia and hyperphosphatasemia, and a radiological survey revealed multiple rib fractures, suggesting complication with osteomalacia. Two years earlier, she had undergone subtotal colectomy for colon cancer. Her serum 25-hydroxy vitamin D concentration was below the detectable level. In addition to a poor nutritional intake and insufficient sun exposure, malabsorption of fatsoluble substances in the intestine and phosphate loss from the kidneys might have contributed to the development of her osteomalacia.

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“…While chronic hypokalemia leads to vacuolar lesions and tubulointerstitial nephritis (TIN), a recent case report describing renal biopsy of an eating disorder patient with intentional vomiting and hypokalemia showed non-uniform progression of TIN, suggesting additional factors contributing to renal disease, such as decreased renal perfusion [ 25 ]. Biopsy in this case revealed wide deposition of crystals and calcium deposits, suggesting nephrocalcinosis which can be seen in diuretic use [ 25 ].…”

Section: Pathophysiology Of Kidney Disease In Eating Disordersmentioning

confidence: 99%

Renal and electrolyte complications in eating disorders: a comprehensive review

Puckett

2023

J Eat Disord

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Eating disorders are psychiatric disorders with significant and widespread medical complications, including renal disorders. Renal disease is not uncommon in patients with eating disorders but is often unrecognized. It includes both acute renal injury and progression to chronic kidney disease requiring dialysis. Electrolyte abnormalities including hyponatremia, hypokalemia, and metabolic alkalosis are common in eating disorders and vary depending on whether patients engage in purging behaviors. Chronic hypokalemia due to purging in patients with anorexia nervosa-binge purge subtype or bulimia nervosa can lead to hypokalemic nephropathy and chronic kidney disease. Additional electrolyte derangements are seen during refeeding, including hypophosphatemia, hypokalemia, and hypomagnesemia. Patients can also develop Pseudo-Bartter’s syndrome which leads to edema and rapid weight gain in patients who cease purging behavior. Clinicians and patients should be aware of these complications in order to provide education and early detection and prevention.

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Non-uniform Progression of Chronic Tubulointerstitial Nephritis and Widespread Nephrocalcification in a Patient with Anorexia Nervosa

Cited by 6 publications

References 15 publications

Improvement in Tubulointerstitial Nephritis With Glucocorticoid Therapy in an Anorexia Nervosa Patient

Improvement in Tubulointerstitial Nephritis With Glucocorticoid Therapy in an Anorexia Nervosa Patient

Vitamin D Deficiency-induced Osteomalacia in a Patient with Anorexia Nervosa

Renal and electrolyte complications in eating disorders: a comprehensive review

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