Advertisement
American Journal of Kidney Diseases

Laxative Abuse, Eating Disorders, and Kidney Stones: A Case Report and Review of the Literature

      Kidney stones are listed among the complications of eating disorders; however, very few cases have been reported. We present an additional case of nephrolithiasis associated with laxative abuse, including detailed results of the patient's urine metabolic profiles, in a patient with idiopathic hypercalciuria. We review the literature and provide an explanation for the paucity of cases of nephrolithiasis associated with these disorders. Despite low urine volumes resulting from extracellular fluid volume depletion and hypocitraturia resulting from hypokalemia, both of which would tend to favor the formation of kidney stones, most patients with eating disorders are likely to be protected from stone formation by the hypocalciuric effect of extracellular fluid volume depletion and increased proximal tubular sodium reabsorption. However, patients with underlying idiopathic hypercalciuria who develop eating disorders may be at increased risk of stone formation in the setting of low urine volume and therefore high supersaturation of calcium oxalate and phosphate.

      Index Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Kidney Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wolff H.P.
        • Vecsei P.
        • Kruck F.
        • et al.
        Psychiatric disturbance leading to potassium depletion, sodium depletion, raised plasma-renin concentration, and secondary hyperaldosteronism.
        Lancet. 1968; 1: 257-261
        • Baker E.H.
        • Sandle G.I.
        Complications of laxative abuse.
        Annu Rev Med. 1996; 47: 127-134
        • Rodman J.S.
        • Sosa R.E.
        • Seidman C.
        • Jones R.
        No More Kidney Stones.
        John Wiley & Sons Inc, Hoboken, NJ2007
        • Silber T.J.
        • Kass E.J.
        Anorexia nervosa and nephrolithiasis.
        J Adolesc Health Care. 1984; 5: 50-52
        • Cachat F.
        • Guignard J.P.
        Too little water intake causing nephrolithiasis, revealed by too much water!.
        Pediatrics. 1999; 104: 578-579
        • Jonat L.M.
        • Birmingham C.L.
        Kidney stones in anorexia nervosa: a case report and review of the literature.
        Eat Weight Disord. 2003; 8: 332-335
        • Komori K.
        • Arai H.
        • Gotoh T.
        • et al.
        A case of ammonium urate urinary stones with anorexia nervosa.
        Acta Urologica Japonica. 2000; 46: 627-629
        • Dick W.H.
        • Lingeman J.E.
        • Preminger G.M.
        • Smith L.H.
        • Wilson D.M.
        • Shirrell W.L.
        Laxative abuse as a cause for ammonium urate renal calculi.
        J Urol. 1990; 143: 244-247
        • Relman A.S.
        • Schwartz W.B.
        The kidney in potassium depletion.
        Am J Med. 1958; 24: 764-773
        • Rutecki G.W.
        • Cox J.W.
        • Robertson G.W.
        • Francisco L.L.
        • Ferris T.F.
        Urinary concentrating ability and antidiuretic hormone responsiveness in the potassium-depleted dog.
        J Lab Clin Med. 1982; 100: 53-60
        • Bindels R.J.
        2009 Homer W. Smith Award: minerals in motion: from new ion transporters to new concepts.
        J Am Soc Nephrol. 2010; 21: 1263-1269
        • Nijenhuis T.
        • Vallon V.
        • van der Kemp A.W.
        • Loffing J.
        • Hoenderop J.G.
        • Bindels R.J.
        Enhanced passive Ca2+ reabsorption and reduced Mg2+ channel abundance explains thiazide-induced hypocalciuria and hypomagnesemia.
        J Clin Invest. 2005; 115: 1651-1658
        • Worcester E.M.
        • Coe F.L.
        New insights into the pathogenesis of idiopathic hypercalciuria.
        Semin Nephrol. 2008; 28: 120-132
        • Fine K.D.
        • Santa Ana C.A.
        • Fordtran J.S.
        Diagnosis of magnesium-induced diarrhea.
        N Engl J Med. 1991; 324: 1012-1017
        • Quamme G.A.
        Renal magnesium handling: new insights in understanding old problems.
        Kidney Int. 1997; 52: 1180-1195
        • Zacchia M.
        • Preisig P.
        Low urinary citrate: an overview.
        J Nephrol. 2010; 23: S49-S56