Acute Oxalate Nephropathy following Ingestion of<i>Averrhoa bilimbi</i>Juice

Nair, Sreeja; George, Jacob; Kumar, Sajeev; Gracious, Noble

doi:10.1155/2014/240936

Cited by 19 publications

(32 citation statements)

References 11 publications

(10 reference statements)

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“…Both the patients took the juice with the belief of improving their diabetes status. Gastrointestinal symptoms have been the most common presenting complaints in all reported cases of oxalatetoxicity [3,5,10,11] aswas the casein our patients. Our first patient also had acute back pain which had also been described by Neto MM, et al [5].…”

Section: Discussionsupporting

confidence: 74%

“…Our first patient also had acute back pain which had also been described by Neto MM, et al [5]. We could not find oxalate crystals in the urine in either cases which could be due to rapid clearance of oxalate crystals [3] or might reflect our inexperience in dealing with such a relatively new entity.…”

Section: Discussionsupporting

confidence: 73%

“…The patient with bilimbi toxicity had diabetic nephropathy whereas all cases of A. bilimbi toxicity reported by Bakul et al [7] had previously normal renal function. As in most reported cases the serum creatinine in both our patients did improve, but AKI remains a risk factor for CKD over the long term and is therefore important [3,5,7].…”

Section: Discussionsupporting

confidence: 63%

“…Although there are several case reports of acute oxalate nephropathy due to multipleagents [12 -15], reports on AKI due to A. bilimbiare very few [3,7,10]. We performed a renal biopsy in both patients and found oxalate crystals in first patient only and features of acute tubular necrosis with tubular dilatation in second.…”

Section: Discussionmentioning

confidence: 77%

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Community Acquired Acute Kidney Injury from Edible Agents: Report from a Developing Country, Bangladesh

Samad¹,

Haque²,

Rahim³

et al. 2017

TOUNJ

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Abstract:Toxin is a common cause of community acquired acute kidney injury (AKI) which includes environmental toxins like plant toxins as well as various drugs and chemicals which are usually ingested for medicinal as well as recreational purposes.Averrhoa carambola (Star fruit/ Kamranga) and Avorrhoa bilimbi are two such commonly used traditional remedies. They belong to family Oxalidaecae and contain high-levels of oxalic acid. AKI may occur after consuming concentrated juice due to deposition of oxalate crystals in the renal tubules.Here we present two patients who developed AKI after ingestion of freshly made juice from A. bilimbi and star fruit. Both patients were diabetic and the juice was ingested on empty stomach with the belief of improving glycemic status. Initial presentation was GI upset in both scenarios. Patient with A. bilimbi toxicity had diabetic nephropathy and required hemodialysis. Renal biopsy revealed deposition of polarizable oxalate crystals in the patient who consumed A. bilimbi and acute tubular necrosis in the patient with star fruit toxicity. All cases regained normal renal function within three months.We also present a patient who ingested raw fish gallbladder as a remedy for asthma. The patient presented with AKI within five days of ingestion and required hemodialysis. His highest serum creatinine was 10.4mg/dl and fell to 1.7 mg/dl after four weeks. Cyprinol and related compounds in fish gallbladder are thought to be the cause of acute tubular necrosis in such cases.The fourth patient developed AKI with rhabdomyolysis after consuming a locally made energy drink. He also required dialysis and serum creatinine gradually improved from 7.2mg/dl to 1.4mg/dl at discharge. The possibility of toxicity of caffeine, adulteration with other chemicals or ascorbic acid toxicity causing oxalate nephropathy could not be excluded.All four patients developed AKI caused after ingesting easily available products and are presented here for public awareness. We believe proper knowledge and education can reduce toxin induced AKI in our society.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionsupporting

confidence: 73%

Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 77%

See 2 more Smart Citations

Community Acquired Acute Kidney Injury from Edible Agents: Report from a Developing Country, Bangladesh

Samad¹,

Haque²,

Rahim³

et al. 2017

TOUNJ

View full text Add to dashboard Cite

show abstract

“…4 High amounts of oxalate make it a nephrotoxic agent. 5 Acute oxalate nephropathy after ingestion of A. bilimbi juice is uncommon. 6 Few cases have been reported in India.…”

Section: Introductionmentioning

confidence: 99%

Acute Oxalate Nephropathy Due to Bilimbi Poisoning: A Case Report

et al. 2016

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Background: The concentrated juice made from Averrhoa bilimbi is rich in oxalic acid. It can cause acute oxalate nephropathy by blocking the tubules with calcium oxalate crystals. Case: An elderly woman was admitted to the hospital with a history of swelling of the legs, facial puffiness, and abdominal distention. Her biochemical study revealed features of acute renal failure. She gave history of taking half liter of bilimbi juice. Renal biopsy confirmed it was a case of acute oxalic nephropathy, which made it the second case of acute oxalic nephropathy due to ingestion of bilimbi juice ever reported from Bangladesh. Conclusion: It is not safe to consume high oxalate-containing fruits in large quantities.

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Circulating human microRNA biomarkers of oxalic acid-induced acute kidney injury

et al. 2020

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Acute Oxalate Nephropathy following Ingestion ofAverrhoa bilimbiJuice

Abstract: Plant toxins are known to cause acute kidney injury in tropical countries. We report two cases of acute kidney injury with tubular oxalate deposition following ingestion of Averrhoa bilimbi fruit juice. Both patients had complete renal recovery though one required dialytic support.

Cited by 19 publications

References 11 publications

Community Acquired Acute Kidney Injury from Edible Agents: Report from a Developing Country, Bangladesh

Community Acquired Acute Kidney Injury from Edible Agents: Report from a Developing Country, Bangladesh

Acute Oxalate Nephropathy Due to Bilimbi Poisoning: A Case Report

Circulating human microRNA biomarkers of oxalic acid-induced acute kidney injury

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