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Abstract: FR-PO106

Kratom Induced Acute Tubular Necrosis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Canela, Victor A., Methodist Health System, Dallas, Texas, United States
  • Collazo-Maldonado, Roberto L., Methodist Health System, Dallas, Texas, United States
Introduction

Kratom (Mitragyna speciosa) is part of the coffee plant family (Rubiceae). Its use has been linked to rural workers in Indonesia and Malaysia but recently has gained popularity in the Western world. The active compounds are indole alkaloids (mitragynine) which act as partial opioid agonists. Its effects are described as a stimulant, analgesics and muscle relaxants. The potential drug to drug interactions, cross contamination and direct kidney injury makes it important for Nephrologists to recognize. This case highlights acute kidney injury in a young patient with daily use of Kratom.

Case Description

A 28 y/o Caucasian man with history of DM type 1 and Psoriasis presented with one week of nausea, vomit and decreased urine output. Medication list included an insulin pump, Enbrel and Valtrex. He reported increased use of daily Kratom pills in the last week for anxiety. On physical exam, his VS were normal but was found to be hypovolemic. BUN was 44 mg/dl, Cr 9.53 mg/dl. Electrolytes, LFT’s CK were normal. Serologies were negative. U/A showed pyuria, 1+ eosinophils, no granular casts, no rbc’s and no crystals. A 24-hr urine had 2 gm of proteinuria. Urine toxicology was negative. Renal U/S had normal kidneys with no hydronephrosis. His kidney function became worse despite adequate intravascular volume expansion; therefore, a kidney biopsy was done and was consistent with acute tubular necrosis. His Cr peaked at 13 mg/dl and kidney function gradually improved without the need of any kidney replacement therapy.

Discussion

Kratom consumption in the United States is unregulated and mostly available at herbal stores. The FDA has recommended to classify as Schedule I substance. We presented a case of oliguric AKI in a patient with Kratom consumption. Drug-to-drug interaction and cross contamination are the main safety concern of this substance. Rhabdomyolysis, acute hepatic and kidney injury have been reported. It is important for the practicing Nephrologist and general clinicians to be aware of such herbal supplements and their presentations. More studies are needed to establish the exact pathogenesis and relation to causality.