Osório Eva, Milheiro Isabel, Brandão Isabel, Roma Torres António
Department of Psychiatry, Centro Hospitalar de São João, EPE, Porto, Portugal.
BMJ Case Rep. 2013 Jan 17;2013:bcr2012007294. doi: 10.1136/bcr-2012-007294.
Anorexia nervosa remains challenging to treat and difficult to prevent. Nearly 5% of affected individuals die of this disease and 20% develop a chronic eating disorder. Anorexia nervosa may be associated with several medical complications of varying severity, including dysfunction of the renal system. Though there are some reports of renal failure in patients with anorexia nervosa, few reports are available concerning patients who required maintenance dialysis. We report a case of a patient with long-term untreated anorexia nervosa-binge eating/purging type who started psychiatric treatment when in a life-threatening situation (renal failure requiring dialysis), with unsuccessful weight recovery while on dialysis and died of septicaemia. The mechanisms that seem to be involved in the development of end-stage renal disease in this patient and the challenges associated with her treatment are reviewed. Patients with anorexia nervosa should be carefully monitored to discover the subtle manifestations of early renal failure.
神经性厌食症的治疗仍然具有挑战性且难以预防。近5%的患者死于该疾病，20%会发展为慢性饮食失调。神经性厌食症可能与多种严重程度不同的医学并发症相关，包括肾脏系统功能障碍。虽然有一些关于神经性厌食症患者肾衰竭的报道，但关于需要维持性透析的患者的报道却很少。我们报告了一例长期未治疗的神经性厌食症-暴饮暴食/清除型患者，该患者在面临危及生命的情况（肾衰竭需要透析）时开始接受精神科治疗，透析期间体重未能成功恢复，最终死于败血症。本文回顾了该患者终末期肾病发生过程中可能涉及的机制以及与她的治疗相关的挑战。对于神经性厌食症患者应进行仔细监测，以发现早期肾衰竭的细微表现。
