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Anorexia Nervosa and the Kidney

Anorexia Nervosa and the Kidney - Trina Banerjee Metabolic...

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Trina Banerjee
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Metabolic Abnormalities of Anorexia Etiologies of Kidney Failure Treatment
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Hypokalemia Hyponatremia Hypercalcemia Hypomagnesemia Hypophosphatemia Metabolic Acidosis
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Decreased Reabsorption of K: K is reabsorbed using the H/K ATPase, which requires an acceptor for the proton in the tubular fluid In anorexia the phosphate stores are low and bicarb will have been reabsorbed proximally Increased Secretion of K: Decreased effective circulating volume results in an increase in aldosterone
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Impaired urinary concentration: Decreased collecting system responsiveness to ADH, with decreased expression of aquaporin-2, when K<3 meq/L Increased renal ammonia production: As K leaves the tubular cell H enters, causing intracellular acidosis The H is then secreted leading to increased ammonia formation
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Low solute ingestion Impaired Osmoregulation
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Case control study 12 patients with anorexia, 10 on antidepressants. 2 control groups: 12 women without anorexia not on antidepressants and 11 women on antidepressants Urine osmolarity measured at baseline and after 12 hour fast
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Compared to women not on antidepressants, anorexics had: Baseline: Identical urine urea and creatinine, identical serum ADH, higher baseline osmolarities Following water deprivation: Minimal increase in ADH, minimal rise in urine osmolarity
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Increased bone breakdown from acidosis, results in hypercalciuria High calcium turns oiff the calcium sensing receptor in the thick ascending tubule shutting off ROM-K, leading to magnesium wasting
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