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

• Published in: American journal of kidney diseases Vol. 60; no. 2; pp. 295 - 298
• Main Authors: Leaf, David E., MD, Bukberg, Phillip R., MD, Goldfarb, David S., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2012; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Anorexia nervosa; Biological and medical sciences; bulimia; citrate; Eating behavior disorders; Feeding and Eating Disorders - complications; Female; Humans; hypercalciuria; Laxatives - adverse effects; Medical sciences; nephrolithiasis; Nephrolithiasis - chemically induced; Nephrolithiasis - complications; Nephrolithiasis - epidemiology; Nephrolithiasis - urine; Nephrology; Nephrology. Urinary tract diseases; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Substance-Related Disorders - complications; Urinary lithiasis; urolithiasis; nephrolithiasis; urolithiasis; bulimia; hypercalciuria; citrate; Anorexia nervosa; Kidney disease; Nephrology; Urinary system disease; Abuse; Citrate; Laxative; Review; Eating disorder; Urology; Urinary stone; Bulimia; Case study; Hypercalciuria; Renal lithiasis; Bibliographic review
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2012.02.337

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.