Star fruit: simultaneous neurotoxic and nephrotoxic effects in people with previously normal renal function

Moysés-Neto, Miguel; Silva, Gyl E. B.; Costa, R. S.; Neto, Osvaldo Merege Vieira; García-Cairasco, Norberto; Lopes, Norberto P.; Haendchen, Priscila F. C.; Silveira, Cintya; Mendes, Alcino R.; Filho, Ramon Ramos; Dantas, Márcio

doi:10.1093/ndtplus/sfp108

Cited by 32 publications

(59 citation statements)

References 12 publications

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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: 73%

“…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]. 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: 61%

“…Hyperoxaluric AKI also may have the characteristic features of acute tubular necrosis [17]. Our second patient had previously normal renal function which is very rarely reported as star-fruit toxicity tends to occur in those with baseline renal dysfunction [5]. 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.…”

Section: Discussionmentioning

confidence: 64%

“…The oxalic acid content of A. bilimbi is highest in half-ripe fruit (8.57-10.32 mg/gm) and that of A. carambola is 80-730 mg/dl [3 -5].Oxalate excretion mainly occurs through the kidneys and therefore an increased oxalate load may predispose to tubular precipitation and renal failure [6,7] the two cases reported here, the first patient took total 500 ml of bilimbi juice in two days and the second patient ingested juice of 500 gram star fruit in one day. Although the exact amount of fruit or juice which may cause renal insufficiency is yet not known [5], it is necessary to determine the minimum amount causing acute oxalate nephropathy. It is also important to identify any additional criteria which might contribute to the AKI.…”

Section: Discussionmentioning

confidence: 99%

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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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