title: "End-stage kidney" in longstanding bulimia nervosa.
abstract: OBJECTIVE
  The extent of renal damage over long-term binge/purges has not been well documented in bulimia nervosa (BN).
  
  
  METHODS
  We describe a 52-year-old woman with longstanding BN subsequent to an 8-year history of anorexia nervosa (AN).
  
  
  RESULTS
  The patient showed chaotic binge/purges and chronic severe hypokalemia after recovery from AN at age 26 years, and renal biopsy showed juxtaglomerular hyperplasia, which was diagnosed as pseudo-Bartter's syndrome.
  
  
  CONCLUSIONS
  Over the following 26 years, the patient's eating behaviors remained chaotic, and her renal function gradually deteriorated. After the patient died of pneumonia and sepsis at age 52 years, autopsy of her kidney showed chronic interstitial nephritis, proximal tubular swelling, and diffuse glomerular sclerosis, suggesting chronic glomerular injury associated with long-term binge/purges. To our knowledge, this is the first case report of a patient with BN with long-term binge/purges who developed an eventual "end-stage kidney" characterized by hypokalemic nephropathy and diffuse glomerulosclerosis.
authors.affiliation: Department of Behavioral Medicine, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima-City, Japan. yasuhara@m3.kufm.kagoshima-u.ac.jp
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yasuhara
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Naruo
authors.forename: Shuhei
authors.initials: S
authors.lastname: Taguchi
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Umekita
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yoshida
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Nozoe
mesh_terms: D000328:Adult; D001284:Atrophy; D002032:Bulimia / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000523:psychology; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D005923:Glomerulosclerosis, Focal Segmental / Q000175:diagnosis / Q000209:etiology / Q000473:pathology / Q000523:psychology; D006801:Humans; D006965:Hyperplasia; D007008:Hypokalemia / Q000175:diagnosis / Q000209:etiology / Q000473:pathology / Q000523:psychology; D007606:Juxtaglomerular Apparatus / Q000473:pathology; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000523:psychology; D007677:Kidney Function Tests; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000175:diagnosis / Q000209:etiology / Q000473:pathology / Q000523:psychology