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Kidney Week

Abstract: PO0218

Chronic Tubulointerstitial Nephropathy and Nephrotic Range Proteinuria in a Patient with an Underlying Eating Disorder

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Bashir, Khawaja Arsalan, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Maturostrakul, Boonyanuth N., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Corona, Antonio, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Bijol, Vanesa, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Jhaveri, Kenar D., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Introduction

Eating disorders in particular atypical anorexia nervosa ; binge eating/purging type, have been reported as an established cause of CKD with chronic tubulointerstitial nephritis as a prominent histopathological feature seen on kidney biopsy.

Case Description

A 40-year-old woman with hypertension, generalized anxiety and an eating disorder was referred to our clinic for new onset nephrotic range proteinuria and elevated serum creatinine (SCr). Patient endorsed remote NSAID use without any recent use. Physical exam notable for uncontrolled hypertension and bilateral lower extremity edema. SCr was elevated at 2.33 mg/dl, higher than 1.6 mg/dl two months prior to evaluation. Urinalysis showed proteinuria and trace hematuria but was otherwise unremarkable. Spot urine TP/CR was elevated at 9.4 gm/gm. Serologic work up including PLA2R antibody levels, ANA, ANCAs, Hep B surface antigen were negative. Serum immunofixation did not reveal any monoclonal bands. Renal sonogram showed bilateral echogenic kidneys with no renal artery stenosis or hydronephrosis. Of note, patient presented with severe hypokalemia (2.2 mmol/L) and hypomagnesemia (0.8 mg/dl), which were found to be chronic. Electrolyte derangements were attributed to purging disorder in the past, however she adamantly denied active purging or diuretic/laxative abuse. She also denied taking any herbal medications.
A kidney biopsy showed widespread fibrosis and advanced global and segmental glomerulosclerosis (more than 50% of gloemruli) with diffuse chronic tubulointerstitial nephropathy (TIN). The tubules also revealed microcystic dilatation with several simple cysts. CKD and TIN were most likely secondary to underlying eating disorder. Lithium exposure can have a similar pattern on histology, however there was no history of lithium use as confirmed by prior providers. Given the chronicity, she was initiated on dialysis. A Renasight genetic test revealed no genetic abnormalities explaining the above findings

Discussion

Diffuse TIN with glomerulosclerosis and widespread fibrosis can be associated with anorexia nervosa. Clinicians should be aware of the potential implications of kidney disease in patients with eating disorders. Early recognition and referral to Nephrologists can help improve outcomes by preventing irreversible kidney damage.