130 bilateral urinomas: a rare presentation of acute kidney injury

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improved but the patient remained anuric. The 'ascitic fluid' drained persistently and grew Proteus mirabilis. Analysis of the fluid showed high level of creatinine, ...
1ST ASIA PACIFIC AKI CRRT 2017 Presenter: Ms HUI YIN TAY Keywords: Aphanizomenan Flos Aquae, AFA, supplements, AKI, CKD Introduction: 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). Case 1: 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). Case 2: 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. Case 3: 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. Case 4: 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. Case 5: 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. Conclusion: 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. Unit for:

Creatinine mmol/L Glomerular Filtration Rate (GFR) mL/min/1.73m2

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Thong, Kah-Mean , Wong, Yik-Hong , Lim, Wei-Mei , Lee, Yee-Yan1, Ramanaidu, Sridhar1, Khor, Heng-Tee3, Baba, Mohd Shaffie4, Loh, Chek-Loong1 1

Division of Nephrology, Department of Medicine, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia, 2KPJ Ipoh Specialist Hospital, Perak, Malaysia, 3Pantai Hospital Ipoh, Perak, Malaysia, 4Department of Radiology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia

Category: Other Presenter: Dr KAH MEAN THONG Keywords: urinoma, acute kidney injury, obstructive uropathy, urine

leak, ultrasound scan Introduction: Ultrasound scan (USS) is a simple and mandatory assessment in patients with acute kidney injury (AKI) to exclude the presence of hydronephrosis and urinary tract obstruction. We report a rare case of AKI due to obstructive uropathy, which was not detectable by USS. Case presentation: A 64 year-old man presented with 4-days history of left sided flank pain with abdominal distension and reduced urine output. An USS revealed multi-septated ascites at left quadrant of the abdomen and normal kidneys. He was treated for spontaneous bacterial peritonitis and required haemodialysis support for progressive AKI. However, his abdominal distension worsened; and pigtail drainage was performed. The renal function improved but the patient remained anuric. The ’ascitic fluid’ drained persistently and grew Proteus mirabilis. Analysis of the S32

HYPOTHYROID INDUCED REVERSIBLE ACUTE KIDNEY INJURY - AN OFTEN FORGOTTEN CAUSE

1 Department of Medicine, Hospital Enche’ Besar Hajjah Khalsom, Kluang, Johor, Malaysia, 86000, 2Nephrology Unit, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia, 56000

BILATERAL URINOMAS: A RARE PRESENTATION OF ACUTE KIDNEY INJURY 1

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Yahya, Noor Hidayah1, Lim, Koo Kim1, Kamaruzaman, Lydia2, Francis, Dhani Darshan1, Woon, Chin Pek1

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fluid showed high level of creatinine, raising suspicions of its origin. Fluroscopy and 4-phase computed tomography renal demonstrated leak of urine into retroperitoneum forming bilateral urinomas. Cystoscopy and biopsy confirmed the diagnosis of invasive urothelial carcinoma. The patient underwent bilateral nephrostomy catheter insertion, trans-urethral resection of the prostate (TURP) and chemotherapy. Conclusions: This case conferred a diagnostic challenge to the treating clinicians. We also highlighted the limitation of USS in this patient’s management. Urinoma is a rare condition that is usually due to acute onset of obstruction caused by urolithiasis, trauma or interventional procedures and surgery. Development of forniceal rupture associated with relatively slow growing tumour is extremely rare due to the compensatory mechanism of reno-ureteral system. This is by far the first reported case of bilateral urinomas caused by invasive prostate carcinoma.

Category: Other Presenter: Dr NOOR HIDAYAH YAHYA Keywords: Acute Kidney Injury, Hypothyroid Introduction: Hypothyroidism is an under-appreciated cause of renal

failure. Hypothyroidism exerts cardiovascular and renal hemodynamic changes result in reduced glomerular filtration rate (GFR) and tubular re-absorption. Hypothyroidism related kidney injury is reversible and if correctly diagnosed, patients can avoid unnecessary procedures such as arteriovenous fistula fashioning. We describe a case of severe hypothyroidism and acute kidney injury requiring hemodialysis, in whom thyroid hormone replacement led to restoration of the renal function. Case Report: A 66-year-old woman presented with lethargy, constipation, and oliguria for 2 weeks. She has 10 years history of diabetes and hypertension for which she takes amlodipine and insulin. Her baseline renal function 1 year prior to admission revealed a urea of 10.6 mmol/L and a creatinine of 146 umol/L. Her eGFR was 33 ml/min/1.73 m2.The skin was coarse with peripheral non-pitting edema. Her mentation was slow with delayed relaxation of the reflexes. There was no goiter. Her laboratory results revealed normochromic normocytic anaemia (Hb 10.9), urea 27.3, creatinine 786, calcium 1.9 and phosphate 2.46. The liver function, creatine kinase, echocardiogram and renal ultrasonography were normal. Urinalysis showed protein 2+. Renal function worsened (urea 31.9, creatinine 926, K 5.6) despite hydration requiring acute hemodialysis. Thyroid function available later revealed severe hypothyroidism (TSH: 23 mIU/L; free T4: 5.3 pmol/L). She received L-thyroxine replacement with initiation dose of 25 ug/d and Kidney International Reports (2017) 2, S1–S41