Virginia Research Day 2025

Medical Student Research Case Reports

01 Acute Kidney Injury Triggered by Vitamin B12-Methylfolate: A Cautionary Tale from Social Media Supplements

Paige O'Brien Daly, MA¹; Kaylie Ward¹; Nathaniel Irvine, M.D.²; Brett Brodsky, D.O.²; Neama Setambar, D.O.²; Sushmita Yadav, D.O.² Corresponding author: pdaly@vcom.edu

¹ Edward Via College of Osteopathic Medicine - Virginia Campus ² Riverside Family Medicine General Surgery, Newport News, VA

Background: Dietary supplement use has been increasing in the United States, with recent data indicating that 70% of adults over 70 reported using at least one supplement in the last 30 days. Unlike prescription drugs, dietary supplements do not require FDA approval, leading to significant variability in quality and potential health risks. Vitamin B12 and folate supplements are commonly used for various health purposes, but high doses have been associated with potential adverse effects, including kidney dysfunction in some cases. This case report highlights the risks associated with unregulated dietary supplements and emphasizes the importance of comprehensive evaluation in cases of unexplained acute kidney injury (AKI).

Case Summary: A 53-year-old female presented to the emergency department with severe gastrointestinal symptoms after starting a vitamin B12-methylfolate supplement purchased through social media. The patient developed AKI, with initial labs revealing severe renal impairment (creatinine 11.76 mg/dL, BUN 59 mg/dL). A renal biopsy was performed, revealing acute tubular necrosis (ATN) and mild acute interstitial nephritis (AIN). Poison control was notified to assess potential supplement contamination. The patient's condition gradually improved with supportive care, and she was discharged after 10 days of hospitalization with instructions for follow-up care.

Conclusion: This case underscores the potential risks associated with unregulated dietary supplements and the importance of thorough medication history in clinical practice. It highlights the need for healthcare providers to maintain a high index of suspicion for supplement-related adverse effects and to consider involving poison control in cases where contamination is suspected. The case also emphasizes the value of renal biopsies in determining the cause of unexplained AKI. Further research is needed to better understand the potential renal effects of high-dose vitamin B12 and folate supplements and to improve regulatory oversight of the supplement industry.

Table of Contents

93

2025 Research Recognition Day