Does hypokalemia contribute to acute kidney injury in chronic laxative abuse?

• Published in: Kidney research and clinical practice Vol. 34; no. 2; pp. 109 - 112
• Main Authors: Lee, Eun-Young, Yoon, Hyaejin, Yi, Joo-Hark, Jung, Woon-Yong, Han, Sang-Woong, Kim, Ho-Jung
• Format: Journal Article
• Language: English
• Published: Korea (South) Elsevier B.V 01.06.2015; Elsevier; The Korean Society of Nephrology; 대한신장학회
• Subjects: Acute kidney injury; Anorexia nervosa; Case Report; Hypokalemia; Hypokalemic nephropathy; Laxative; Nephrology; 내과학; Hypokalemia; Hypokalemic nephropathy; Laxative; Anorexia nervosa; Acute kidney injury
• ISSN: 2211-9132; 2211-9140
• DOI: 10.1016/j.krcp.2014.10.009

Abstract Prolonged hypokalemia from chronic laxative abuse is recognized as the cause of chronic tubulointerstitial disease, known as “hypokalemic nephropathy,” but it is not clear whether it contributes to acute kidney injury (AKI). A 42-year-old woman with a history of chronic kidney disease as a result of chronic laxative abuse from a purging type of anorexia nervosa (AN-P), developed an anuric AKI requiring hemodialysis and a mild AKI 2 months later. Both episodes of AKI involved severe to moderate hypokalemia (1.2 and 2.7 mmol/L, respectively), volume depletion, and mild rhabdomyolysis. The histologic findings of the first AKI revealed the remnants of acute tubular necrosis with advanced chronic tubulointerstitial nephritis and ischemic glomerular injury. Along with these observations, the intertwined relationship among precipitants of recurrent AKI in AN-P is discussed, and then we postulate a contributory role of hypokalemia involved in the pathophysiology of the renal ischemia-induced AKI.