Keywords
kidney damage
pathophysiology
How to Cite
Abstract
Eating Disorders (EDs), which are classified as psychoneurotic diseases, are defined by disordered eating habits that may involve insufficient or excessive food consumption, which is detrimental to a person's physical and mental health. According to current data, there is a close connection between eating disorders and damage to endocrine system and kidney functions. Patients with anorexia nervosa need both psychological and physical support. This review describes the underlying pathophysiological processes of the endocrine, renal, and electrolyte disturbances observed in patients with EDs. The purpose of the review is to present all aspects related to disorders of the function of the endocrine system and kidneys in EDs. Human organisms can adapt to changes in environment, including nutrition. However, compensatory mechanisms are temporary in terms of adaptation to malnourishment. One of the systems which is susceptible and impacted is the endocrine system. Disorders of the endocrine system in patients with EDs are multi-vector and include disorders of the hypothalamic-pituitary-gonadal system, thyroid gland, insulin system, growth hormone, gonads, leptin-ghrelin system. Background metabolic disorders in EDs are hypokalemia, hyponatremia, hypomagnesemia, metabolic alkalosis. They participate in the occurrence and progression of kidney damage. The compensatory functions of the kidneys are preserved until a certain time, which is determined by the level of water-electrolyte, metabolic disorders, tubulo-interstitial damage. The main morphological forms of kidney damage in patients with EDs are nephrocalcinosis and nephrolithiasis, clinical forms are acute kidney damage and chronic kidney disease. The multi-vector nature of disorders in EDs requires a comprehensive multidisciplinary approach. Management of patients with EDs requires a multidisciplinary approach.
Keywords: endocrine disorders, kidney damage, pathophysiology.
Archived: https://doi.org/10.5281/zenodo.13347247
References
Westmoreland P, Krantz MJ, Mehler PS. Medical Complications of Anorexia Nervosa and Bulimia. Am J Med. 2016;129(1):30-7. DOI: 10.1016/j.amjmed.2015.06.031. PMID: 26169883.
Meule A, von Rezori V, Blechert J. Food addiction and bulimia nervosa. Eur Eat Disord Rev. 2014;22(5):331-7. DOI: 10.1002/erv.2306. PMID: 24995543.
Marumoto H, Sasaki T, Tsuboi N, Ito T, Ishikawa M, Ogura M, et al. Kidney Disease Associated with Anorexia Nervosa: A Case Series with Kidney Biopsies. Kidney Med. 2020;2(4):418-24. DOI: 10.1016/j.xkme.2020.03.007. PMID: 32775981.
Bouquegneau A, Dubois BE, Krzesinski JM, Delanaye P. Anorexia nervosa and the kidney. Am J Kidney Dis. 2012;60(2):299-307. DOI: 10.1053/j.ajkd.2012.03.019. PMID: 22609034.
Currin L, Schmidt U, Treasure J. Time trends in eating disorder incidence. Br J Psychiatry. 2005;186:132-5. DOI: 10.1192/bjp.186.2.132. PMID: 15684236.
Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord. 2003;34:383-96. DOI: 10.1002/eat.10222. PMID: 14566926.
Lock JD, Fitzpatrick KK. Anorexia nervosa. BMJ Clin Evid. 2009;10:1011-128. PMID: 19445758.
Puckett L. Renal and electrolyte complications in eating disorders: a comprehensive review. J Eat Disord. 2023;11(1):26. DOI: 10.1186/s40337-023-00751-w. PMID: 36803805.
Melanie S Haines. Endocrine complications of anorexia nervosa. J Eat Disord. 2023;11(1):24. DOI: 10.1186/s40337-023-00744-9.
Mehler PS, Andersen AE. Eating Disorders: A Comprehensive Guide to Medical Care and Complications (fourth edition). Eat Weight Disord. 2022;27(8):2987-88. DOI: 10.1007/s40519-022-01479-3. PMID: 36199010.
Wong HK, Hoermann R, Grossmann M. Reversible male hypogonadotropic hypogonadism due to energy deficit. Clinical Endocrinology. 2019;91(1):3-9. DOI: 10.1111/cen.13973. PMID: 30903626.
Singhal V, Nimmala S, Slattery M, Eddy KT, Miller KK, Klibanski A, Misra M. Physiologic transdermal estradiol replacement mimics effects of endogenous estrogen on bone outcomes in hypoestrogenic women with anorexia nervosa. Nutrients. 2022;14(13):2557. DOI: 10.3390/nu14132557. PMID: 35807738.
Kano M, Muratsubaki T, Van Oudenhove L, Morishita J, Yoshizawa M, Kohno K, et al. Altered brain and gut responses to corticotropin-releasing hormone (CRH) in patients with irritable bowel syndrome. Scientific Reports. 2017;7(1):12425. DOI: 10.1038/s41598-017-09635-x. PMID: 28963545.
Dostalova I, Haluzik M. The role of ghrelin in the regulation of food intake in patients with obesity and anorexia nervosa. Physiological Research, 2009;58(2):159-70. DOI: 10.33549/physiolres.931448. PMID: 18380540.
Hoenig MP, Hladik GA. Overview of Kidney Structure and Function. National Kidney Foundation's Primer on Kidney Diseases. 2018;(7):2-18. DOI: 10.1016/B978-0-323-47794-9.00001-9.
Mabillard H, Sayer JA. Metabolic Alkalosis. Fluid and Electrolyte Disorders. 2018;3:61-76. DOI: 10.5772/intechopen.78724.
Brotman AW, Sterll TA, Brotman DL. Renal disease and dysfunction in two patients with anorexia nervosa. J Clin Psychiatry. 1986;47(8):433-4. PMID: 3733679.
Palla B, Litt IF. Medical complications of eating disorders in adolescents. Pediatrics. 1988;81:613-23. DOI: 10.1542/peds.81.5.613.
Zipfel S, Lowe B, Reas DL. Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study. Lancet. 2000;355:721-2. DOI: 10.1016/S0140-6736(99)05363-5. PMID: 10703806.
Puckett L, Mehler S, Mehler P. Kidney disease as a medical complication of eating disorders. Nat Rev Nephrol. 2022;18(11):677-8. DOI: 10.1038/s41581-022-00610-y.
Riva A, Pigni M, Nacinovich R. Renal dysfunctions and clinical correlates in adolescents with restrictive anorexia nervosa. Clin Nutr ESPEN. 2021;43:230-4. DOI: 10.1016/j.clnesp.2021.04.011. PMID: 34024519.
Osorio E, Milheiro I, Brandao I, Roma Torres A. Anorexia nervosa and dialysis: we have no time when the body is so damaged. BMJ Case Rep. 2013;2013:bcr2012007294. DOI: 10.1136/bcr-2012-007294. PMID: 23329707.
Talbot BE, Lawman SH. Eating disorders should be considered in the differential diagnosis of patients presenting with acute kidney injury and electrolyte derangement. BMJ Case Rep. 2014;2014:bcr2013203218. DOI: 10.1136/bcr-2013-203218. PMID: 24654247.
Mehler PS, Walsh K. Electrolyte and acid-base abnormalities associated with purging behaviors. Int J Eat Disord. 2016;49(3):311-8. DOI: 10.1002/eat.22503. PMID: 2687628.
Reungjui S, Roncal CA, Sato W. Hypokalaemic nephropathy is associated with impaired angiogenesis. J Am Soc Nephrol. 2008;19:125-34. DOI: 10.1681/ASN.2007030261. PMID: 18178802.
Lee EY, Yoon H, Yi JH, Jung WY, Han SW, Kim HJ. Does hypokalemia contribute to acute kidney injury in chronic laxative abuse? Kidney Res Clin Pract. 2015;34(2):109-12. DOI: 10.1016/j.krcp.2014.10.009. PMID: 26484031.
Yalamanchili HB, Calp-Inal S, Zhou XJ, Choudhury D. Hypokalemic nephropathy. Kidney Int Rep. 2018;3(6):1482-8. DOI: 10.1016/j.ekir.2018.07.014. PMID: 30450476.
Elitok S, Bieringer M, Schneider W, Luft FC. Kaliopenic nephropathy revisited. Clin Kidney J. 2016;9(4):543-6. DOI: 10.1093/ckj/sfv154. PMID: 27478593.
Macdonald J, Marcora S, Jibani M, et al. GFR estimation using cystatin C is not independent of body composition. Am J Kidney Dis. 2006;48(5):712-9. DOI: 10.1053/j.ajkd.2006.07.001. PMID: 17059990.
Peebles R, Sieke EH. Medical Complications of Eating Disorders in Youth. Child Adolesc Psychiatr Clin N Am. 2019;28(4):593-615. DOI: 10.1016/j.chc.2019.05.009. PMID: 31443878.
Sharp CW, Freeman CP. The medical complications of anorexia nervosa. Br J Psychiatry 1993;162:452-62. DOI: 10.1192/bjp.162.4.452. PMID: 8481735.
Lim AK, Hooke DH, Kerr PG. Anorexia nervosa and senna misuse: nephrocalcinosis, digital clubbing and hypertrophic osteoarthropathy. Med J Aust. 2008;188(2):121-2. DOI: 10.5694/j.1326-5377.2008.tb01540.x. PMID: 18205591.
Simhadri PK, Leslie SW. Calcium Deposition and Other Renal Crystal Diseases. 11 Jan 2024. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. PMID: 38261666.
Wada S, Nagase T, Koike Y. A case of anorexia nervosa with acute renal failure induced by rhabdomyolysis; possible involvement of hypophosphatemia or phosphate depletion. Intern Med. 1992;31:478-82. DOI: 10.2169/internalmedicine.31.478. PMID: 1633352.
Mehler PS, Blalock DV, Walden K, Kaur S, McBride J, Walsh K, et al. Medical findings in 1026 consecutive adult inpatient-residential eating disordered patients. Int J Eat Disord. 2018;51(4):305-13. DOI: 10.1002/eat.22830. PMID: 29417593.
Gibson D, Watters A, Cost J, Mascolo M, Mehler PS. Extreme anorexia nervosa: medical findings, outcomes, and inferences from a retrospective cohort. J Eat Disord. 2020;8:25. DOI: 10.1186/s40337-020-00303-6. PMID: 32582446.
Miller KK, Grinspoon SK, Ciampa J, Hier J, Herzog D, Klibanski A. Medical findings in outpatients with anorexia nervosa. Arch Intern Med. 2005;165:561-6. DOI: 10.1001/archinte.165.5.561. PMID: 15767533.
Randall RE Jr, Cohen MD, Spray CC Jr. Hypermagnesemia in renal failure. Etiology and toxic manifestations. Ann Intern Med. 1964;61:73-88. DOI: 10.7326/0003-4819-61-1-73. PMID: 14178364.
Tolins JP, Hostetter MK, Hostetter TH. Hypokalemic nephropathy in the rat. Role of ammonia in chronic tubular injury. J Clin Invest. 1987;79:1447-58. DOI: 10.1172/JCI112973. PMID: 3553240.
Wigley RD. Potassium deficiency in anorexia nervosa, with reference to renal tubular vacuolation. Br Med J. 1960;2(5192):110-3. DOI: 10.1136/bmj.2.5192.110. PMID: 13844697.
Aperia A, Broberger O, Fohlin L. Renal function in anorexia nervosa. Acta Paediatr Scand. 1978;67:219-24. DOI: 10.1111/j.1651-2227.1978.tb16306.x. PMID: 626079.
Comerci GD. Medical complications of anorexia nervosa and bulimia nervosa. Med Clin North Am 1990;74:1293-310. DOI: 10.1016/j.amjmed.2015.06.031. PMID: 26169883.
Taugner R, Waldherr R, Seyberth HW. The juxtaglomerular apparatus in Bartter's syndrome and related tubulopathies. An immunocytochemical and electron microscopic study. Virchows Arch A Pathol Anat Histopathol. 1988;412:459-70. DOI: 10.1007/BF00750580. PMID: 3128915.
Nitsch A, Dlugosz H, Gibson D, Mehler PS. Medical complications of bulimia nervosa. Cleve Clin J Med. 2021;88(6):333-43. DOI: 10.3949/ccjm.88a.20168. PMID: 34078617.
Mehler PS, Watters A, Joiner T, Krantz MJ. What accounts for the high mortality of anorexia nervosa? Int J Eat Disord. 2022;55(5):633-6. DOI: 10.1002/eat.23664. PMID: 34997783.
Krogulska A, Nowicka D, Nowicki Z, Parzecka M, Sakson-Słominska A, Kuczynska R. A loss of consciousness in a teenage girl with anorexia nervosa, due to polydipsia: case report and a minireview. Eat Weight Disord. 2019;24(5):969-74. DOI: 10.1007/s40519-018-00636-x. PMID: 30712218.
Bahia A, Chu ES, Mehler PS. Polydipsia and hyponatremia in a woman with anorexia nervosa. Int J Eat Disord. 2011;44(2):186-8. DOI: 10.1002/eat.20792. PMID: 20127934.
Levy-Shraga Y, David D, Vered I, Kochavi B, Stein D, Modan-Moses D. Hyponatremia and decreased bone density in adolescent inpatients diagnosed with anorexia nervosa. Nutrition. 2016;32(10):1097-102. DOI: 10.1016/j.nut.2016.03.015. PMID: 27222345.
Li Cavoli G, Mule G, Rotolo U. Renal involvement in psychological eating disorders. Nephron Clin Pract. 2011;119:338-41. DOI: 10.1159/000333798. PMID: 22135793.
Mehler PS. Medical complications of bulimia nervosa and their treatments. Int J Eat Disord. 2011;44(2):95-104. DOI: 10.1002/eat.20825. PMID: 21312201.
Raj KS, Keane-Miller C, Golden NH. Hypomagnesemia in adolescents with eating disorders hospitalized for medical instability. Nutr Clin Pract. 2012;27(5):689-94. DOI: 10.1177/0884533612446799. PMID: 22683565.
Stheneur C, Bergeron S, Lapeyraque AL. Renal complications in anorexia nervosa. Eat Weight Disord. 2014;19(4):455-60. DOI: 10.1007/s40519-014-0138-z. PMID: 24997544.
Reber E, Friedli N, Vasiloglou MF, Schuetz P, Stanga Z. Management of refeeding syndrome in medical inpatients. J Clin Med. 2019;8(12):2202. DOI: 10.3390/jcm8122202. PMID: 31847205.
Luthra M, Davids MR, Shafiee MA, Halperin ML. Anorexia nervosa and chronic renal insufficiency: a prescription fordisaster. Qjm. 2004;97(3):167-78. DOI: 10.1093/qjmed/hch031. PMID: 14976274.
Sharma SHM, Castro D. Hypophosphatemia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 29630224.
De Silva A, Nightingale JMD. Refeeding syndrome: physiological background and practical management. Frontline Gastroenterol. 2019;11(5):404-9. DOI: 10.1136/flgastro-2018-101065. PMID: 32884632.
Inker LA, Titan S. Measurement and estimation of GFR for use in clinical practice: core curriculum 2021. Am J Kidney Dis. 2021;78(5):736-49. DOI: 10.1053/j.ajkd.2021.04.016. PMID: 34518032.
Trahan C, Lapeyraque AL, Sznajder M, Frappier JY, Jamoulle O, Taddeo D, et al. In malnourished adolescent with anorexia nervosa, Cockroft–Gault formula is the most relevant formula to estimate renal function. Clin Nutr. 2020;39(6):1914-8. DOI: 10.1016/j.clnu.2019.08.014. PMID: 31495736.
Delanaye P, Cavalier E, Radermecker RP, et al. Estimationof GFR by different creatinine- and cystatin-C-based equations inanorexia nervosa. Clin Nephrol. 2009;71(5):482-91. DOI: 10.5414/cnp71482. PMID: 19473607.
Seronie-Vivien S, Delanaye P, Pieroni L, Mariat C, Frois-sart M, Cristol JP. Cystatin C: current position and future prospects. Clin Chem Lab Med. 2008;46(12):1664-86. DOI: 10.1515/CCLM.2008.336. PMID: 18973461.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.