背景:尽管在营养不良的神经性厌食症(AN)患者中越来越多地报道肾损害,在目前的实践中仍然被低估,常伴有急性脱水.我们研究的目的是评估频率,程度,以及在AN专科医院住院的青少年和成人肾脏受累的危险因素。
方法:在这项多中心研究中,197名连续参与者被包括在内,13-65岁,来自11个住院饮食失调精神科。关于AN课程的信息,临床特征,生物数据,并收集了药物。
结果:入院时,平均BMI为13.1(±1.6)kg/m2,平均年龄20.74(±6.5)岁,z评分为-3.6(±1.33).六名参与者(3.0%)有低钠血症,4人(2.0%)有低钾血症,9人(4.5%)有低氯血症。21名(10.6%)参与者的血液尿素氮/肌酐比率超过20。平均血浆肌酐为65.22(±12.8)µmol/L,平均eGFR为74.74(±18.9)ml/min。35名参与者(17.8%)的eGFR>90毫升/分钟,123(62.4%)从60到90毫升/分钟,35(17.8%)从45到60毫升/分钟,和4(2%)在45ml/min下。在多变量分析中,仅入院时的BMI是肾功能损害的决定因素.BMI越低,肾功能损害越严重。
结论:计算eGFR时,它强调了在需要在专业单位住院的严重AN中发现的肾功能障碍。营养不良的严重程度是一个独立的相关因素。使用eGFR进行肾功能测试,除了肌酐之外,应作为AN患者常规护理的一部分,以检测潜在的肾功能障碍。
AN是一种具有有机影响的精神疾病,并不总是可见的,也不经常被调查。肾损害,如果检测到,通常归因于脱水,并且被认为是快速可逆的。因此,对其严重性和演变的评估不是系统的,即使是在专门为AN患者提供护理的饮食失调单位。我们的研究探索了使用eGFR计算在精神科住院的青少年和成人中肾功能损害的评估。我们的结果表明,住院患者中只有不到18%的患者肾功能正常,并且在各种标准中,仅入院时的BMI与损伤程度相关.在所有需要神经性厌食症住院的情况下,应常规通过eGFR计算而不仅仅通过肌酐测量来评估肾功能。不管住院的原因是什么。
BACKGROUND: Although renal damage is increasingly reported among the most undernourished patients with Anorexia Nervosa (AN), it remains underestimated in current practice, and often associated with acute dehydration. The purpose of our study was to evaluate the frequency, the extent, and the risk factors of renal involvement among adolescents and adults hospitalized in specialized units for AN.
METHODS: In this multi-center study, 197 consecutive participants were included, aged 13-65, from 11 inpatient eating disorder psychiatric units. Information on the course of AN, clinical characteristics, biological data, and medication were collected.
RESULTS: At admission, mean BMI was 13.1 (± 1.6) kg/m2 for a mean age of 20.74 (± 6.5) years and the z-score was - 3.6 (± 1.33). Six participants (3.0%) had hyponatremia, four (2.0%) had hypokalemia, and nine (4.5%) had hypochloremia. The Blood Urea Nitrogen/Creatinine ratio was over 20 for 21 (10.6%) participants. The mean plasma creatinine was 65.22 (± 12.8) µmol/L, and the mean eGFR was 74.74 (± 18.9) ml/min. Thirty- five participants (17.8%) had an eGFR > 90 ml/min, 123 (62.4%) from 60 to 90 ml/min, 35 (17.8%) from 45 to 60 ml/min, and 4 (2%) under 45 ml/min. In multivariate analysis, only BMI on admission was a determinant of renal impairment. The lower the BMI the more severe was the renal impairment.
CONCLUSIONS: When eGFR is calculated, it highlights renal dysfunction found in severe AN requiring hospitalisation in specialized units. The severity of undernutrition is an independent associated factor. Kidney functionality tests using eGFR, in addition to creatinine alone, should be part of routine care for patients with AN to detect underlying renal dysfunction.
AN is a psychiatric illness with organic repercussions that are not always visible nor frequently investigated. Renal damage, if detected, is often attributed to dehydration, and is thought to be rapidly reversible. Assessment of its severity and evolution is therefore not systematic, even in eating disorder units specialised in the care of patients with AN. Our study explored the assessment of renal impairment among adolescents and adults hospitalized in psychiatric units using eGFR calculation. Our results showed that fewer than 18% of the patients hospitalized had normal renal function and that among the various criteria, only BMI on admission was related to the extent of this impairment. Assessment of renal function by eGFR calculation and not only by creatinine measures should be performed routinely in all situations requiring hospitalization in anorexia nervosa, regardless of the reason for hospitalization.