115 SINGLE CENTER CASE REPORT: ACUTE KIDNEY INJURY (AKI) SECONDARY TO APHANIZOMENAN FLOS AQUAE (AFA) EXTRACT

Abstract

Category: Other Presenter: Ms HUI YIN TAY Keywords: Aphanizomenan Flos Aquae, AFA, supplements, AKI, CKD The use of alternative remedies or supplements is highly prevalent likely due to lack of trust in modern medicine. Aphanizomenan Flos Aquae (AFA), a type of blue green algae is one of the remedies that is gaining popularity in Malaysia. We report 5 cases of AKI secondary to a supplement containing AFA extract in patients with Chronic Kidney Disease (CKD). 44-year-old male with CKD, Diabetes (DM), Hypertension (HPT) and Congestive Cardiac Failure (CCF) had a baseline serum creatinine (SCr) of 252 (GFR 26) in Apr 2016. His SCr remained stable until Jan 2017 when it increased to 701 (GFR 7) and subsequently 1467 (GFR 3) in Feb 2017. He had been taking AFA extract since Dec 2016. He was later admitted for uremia and started on regular haemodialysis (HD). 56-year-old female with CKD, DM, HPT, CCF and a baseline SCr of 326 (GFR 13) complained of vomiting for 1 week during a clinic visit in Feb 2017. Her SCr had risen from 486 (GFR 8) in Oct 2016 to 878 (GFR 4) in Jan 2017. She admitted to taking AFA extract for the past 2 months. Her DM and HPT profile have been good during follow up. She is currently undergoing peritoneal dialysis. A 58-year-old male with CKD, DM and HPT had doubling of SCr from 189 (GFR 32) in Sept 2016 to 450 (GFR 12) in Feb 2017. He had been consuming AFA extract from Nov 2016 till early Jan 2017. A repeat SCr 2 and 4 weeks later improved to 375 (GFR 14) and 351(GFR 16). Right obstructive uropathy was noted on ultrasonography in Mar 2017 and he underwent retrograde stenting to relief the obstruction. His SCr improved further to 241 (GFR 26) in May 2017. 71-year-old male had stable SCr ranging from 300 to 340 (GFR 15-17). It gradually worsened in Jul 2016 when he started taking AFA extract from Jun 2016. He has CKD, DM, HPT and Ischeamic Heart Disease. SCr in Feb 2017 was 426 (GFR 11). His SCr reduced to 289 (GFR 19) 3 weeks after stopping the supplement. 63-year-old lady with CKD and HPT was admitted in Jan 2017 with uremia and oliguria after taking AFA extract for 2 days. Admission SCr was 1387 (GFR 2). Her SCr in Dec 2016 was 704 (GFR 5) which slowly rose from 400 (GFR11) since 2013. She needed acute dialysis and is now on regular HD. The significant worsening of renal function with AFA extract in CKD patients is of great concern. A thorough investigation of the product would be enlightening including histopathology evidence. Public awareness and regulation of the use of supplements are important.