Marumoto Hirokazu, Sasaki Takaya, Tsuboi Nobuo, Ito Tatsuhiko, Ishikawa Masahiro, Ogura Makoto, Ikeda Masato, Yokoo Takashi
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan.
Kidney Med. 2020 Jun 5;2(4):418-424. doi: 10.1016/j.xkme.2020.03.007. eCollection 2020 Jul-Aug.
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.
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.
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, 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.
The sample size was small, and kidney function was assessed based on serum creatinine levels in patients with anorexia nervosa with low muscle mass.
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.
神经性厌食症通常难以治疗，并会引发各种身体疾病，包括肾脏疾病和矿物质紊乱，偶尔会发展为肾衰竭。对于转诊至肾病科医生处的神经性厌食症患者，尚未建立基于共识的临床实践指南。
对诊断为神经性厌食症相关肾病的患者进行回顾性分析。肾脏结局定义为血清肌酐水平翻倍和/或进展为终末期肾病。
纳入1992年至2017年间转诊至我院的有神经性厌食症病史且患有肾病（包括电解质异常）的患者。
纳入14名女性患者。从神经性厌食症发病到首次就诊肾病科医生的时间为17.8年。首次就诊时，中位体重指数为13.4kg/m，中位血清肌酐水平为1.9mg/dL，中位血清钾水平为2.7mmol/L。所有患者均表现为低钾血症以及成瘾性呕吐或滥用利尿剂/泻药。在中位观察期3.1年期间，9名患者出现肾脏结局，2名患者因神经性厌食症死亡。4名患者接受了肾脏活检。这些患者的肾脏活检结果包括肾小球旁器肥大、严重的肾小球塌陷和间质纤维化，符合缺血性肾损伤和低钾性肾病。
样本量小，且对肌肉量低的神经性厌食症患者的肾功能评估基于血清肌酐水平。
大多数转诊至肾病科医生处的神经性厌食症患者在首次就诊时就患有肾病。改善神经性厌食症患者的肾脏结局可能需要精神科医生和肾病科医生更早地合作。
