Electrolyte Blood Press.  2018 Jun;16(1):15-17. 10.5049/EBP.2018.16.1.15.

Interstitial Nephritis Caused by Anorexia Nervosa in Young Male; A Case Report and Literature Review

• Choi JW
• Kwon SK
• Kim SM
• Cho H
• Lee HC
• Kim HY

• KMID: 2416375
• DOI: http://doi.org/10.5049/EBP.2018.16.1.15

Abstract

Severe eating disorders characterized by repetitive episodes of purging and vomiting can occasionally trigger acute kidney injury. However, interstitial nephritis induced by episodes of repeated vomiting has rarely been reported, and the pathophysiology of this entity remains unknown. A 26-year-old man was admitted to our hospital because of known hypokalemia. His serum electrolyte profile showed: sodium 133 mEq/L, potassium 2.6 mEq/L, chloride 72 mEq/L, total carbon dioxide 50 mEq/L, blood urea nitrogen/creatinine ratio (BUN/Cr) 21.9/1.98 mg/dL, and magnesium 2.0 mg/dL. Arterial blood gas analysis showed: pH 7.557, partial pressure of carbon dioxide 65.8 mmHg, and bicarbonate 58.5 mEq/L. His urinary potassium concentration was 73.2 mEq/L, and Cr was 111 mg/dL. Renal biopsy revealed acute tubular necrosis and tubulointerstitial nephritis with a few shrunken glomeruli. Repeated psychogenic vomiting may precipitate acute kidney injury and interstitial nephritis secondary to volume depletion and hypokalemia. Serum electrolyte levels and renal function should be carefully monitored in patients diagnosed with eating disorders to prevent tubular ischemia and interstitial nephritis.

Keyword

Interstitial nephritis; anorexia; hypokalemia; tubular necrosis

MeSH Terms

Acute Kidney Injury
Adult
Anorexia Nervosa*
Anorexia*
Biopsy
Blood Gas Analysis
Carbon Dioxide
Eating
Humans
Hydrogen-Ion Concentration
Hypokalemia
Ischemia
Magnesium
Male*
Necrosis
Nephritis, Interstitial*
Partial Pressure
Potassium
Sodium
Urea
Vomiting
Carbon Dioxide
Magnesium
Potassium
Sodium
Urea

Figure

• 

  Fig. 1 (A) Renal tubules showing calcification below the epithelial cells (arrow) without definite glomerular abnormality (hematoxylin and eosin, ×400). (B) Vacuolar changes in the cytoplasm of cells of the proximal tubular epithelium. Mild nuclear variation, implying regeneration after acute damage, is also apparent (hematoxylin and eosin, ×400).

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