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Star fruit toxicity: a cause of both acute kidney injury and chronic kidney disease: a report of two cases.

Abstract

BACKGROUND

Star fruit (Averrhoa carambola) is commonly consumed as a herbal remedy for various ailments in tropical countries. However, the dangers associated with consumption of star fruit are not commonly known. Although star fruit induced oxalate nephrotoxicity in those with existing renal impairment is well documented, reports on its effect on those with normal renal function are infrequent. We report two unique clinical presentation patterns of star fruit nephrotoxicity following consumption of the fruit as a remedy for diabetes mellitus-the first, in a patient with normal renal function and the second case which we believe is the first reported case of chronic kidney disease (CKD) due to prolonged and excessive consumption of star fruits.

CASE PRESENTATION

The first patient is a 56-year-old female diabetic patient who had normal renal function prior to developing acute kidney injury (AKI) after consuming large amount of star fruit juice at once. The second patient, a 60-year-old male, also diabetic presented with acute on chronic renal failure following ingestion of a significant number of star fruits in a short duration with a background history of regular star fruit consumption over the past 2-3 years. Both had histologically confirmed oxalate induced renal injury. The former had histological features of acute tubulo-interstitial disease whilst the latter had acute-on-chronic interstitial disease; neither had histological evidence of diabetic nephropathy. Both recovered over 2 weeks without the need for haemodialysis.

CONCLUSION

These cases illustrate the importance of obtaining the patient's detailed history with respect to ingestion of herbs, traditional medication and health foods such as star fruits especially in AKI or CKD of unknown cause.

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  • Authors+Show Affiliations

    ,

    Nephrology and Transplantation Unit, Teaching Hospital, Kandy, Sri Lanka. rajithaasa55@gmail.com.

    ,

    Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka. suwijetunge@gmail.com.

    ,

    Nephrology and Transplantation Unit, Teaching Hospital, Kandy, Sri Lanka. nishansrikandy@yahoo.co.in.

    ,

    Nephrology and Transplantation Unit, Teaching Hospital, Kandy, Sri Lanka. awmwazil@hotmail.com.

    ,

    Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka. neela72002@yahoo.com.

    ,

    Department of Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka. thilakj@gmail.com.

    Department of Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka. arjuna.medagama@gmail.com.

    Source

    BMC research notes 8: 2015 pg 796

    MeSH

    Acute Kidney Injury
    Averrhoa
    Female
    Fruit
    Humans
    Male
    Middle Aged
    Oxalates
    Renal Insufficiency, Chronic

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    26680759

    Citation

    TY - JOUR T1 - Star fruit toxicity: a cause of both acute kidney injury and chronic kidney disease: a report of two cases. AU - Abeysekera,R A, AU - Wijetunge,S, AU - Nanayakkara,N, AU - Wazil,A W M, AU - Ratnatunga,N V I, AU - Jayalath,T, AU - Medagama,A, Y1 - 2015/12/17/ PY - 2014/11/29/received PY - 2015/10/27/accepted PY - 2015/12/17/aheadofprint PY - 2015/12/19/entrez PY - 2015/12/19/pubmed PY - 2016/9/7/medline SP - 796 EP - 796 JF - BMC research notes JO - BMC Res Notes VL - 8 N2 - BACKGROUND: Star fruit (Averrhoa carambola) is commonly consumed as a herbal remedy for various ailments in tropical countries. However, the dangers associated with consumption of star fruit are not commonly known. Although star fruit induced oxalate nephrotoxicity in those with existing renal impairment is well documented, reports on its effect on those with normal renal function are infrequent. We report two unique clinical presentation patterns of star fruit nephrotoxicity following consumption of the fruit as a remedy for diabetes mellitus-the first, in a patient with normal renal function and the second case which we believe is the first reported case of chronic kidney disease (CKD) due to prolonged and excessive consumption of star fruits. CASE PRESENTATION: The first patient is a 56-year-old female diabetic patient who had normal renal function prior to developing acute kidney injury (AKI) after consuming large amount of star fruit juice at once. The second patient, a 60-year-old male, also diabetic presented with acute on chronic renal failure following ingestion of a significant number of star fruits in a short duration with a background history of regular star fruit consumption over the past 2-3 years. Both had histologically confirmed oxalate induced renal injury. The former had histological features of acute tubulo-interstitial disease whilst the latter had acute-on-chronic interstitial disease; neither had histological evidence of diabetic nephropathy. Both recovered over 2 weeks without the need for haemodialysis. CONCLUSION: These cases illustrate the importance of obtaining the patient's detailed history with respect to ingestion of herbs, traditional medication and health foods such as star fruits especially in AKI or CKD of unknown cause. SN - 1756-0500 UR - https://www.unboundmedicine.com/medline/citation/26680759/full_citation L2 - http://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-015-1640-8 ER -