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Acute Kidney Injury Following Star Fruit Ingestion: A Case Series.
Wilderness Environ Med. 2021 Mar; 32(1):98-101.WE

Abstract

Star fruit (Averrhoa carambola) is a popular fruit in many tropical countries, including Sri Lanka. It is rich in oxalic acid, which is nephrotoxic in higher concentrations. The development of both acute (AKI) and chronic kidney injury after oxalate nephropathy is often underrecognized. Here we discuss the risk factors, clinical features, treatment, and outcomes of 4 patients who developed AKI after star fruit ingestion. Baseline clinical characteristics, the amount of star fruit ingested, clinical presentation, investigation, and outcome of the patients (ages 28, 50, 54, and 55 y; all male) were traced. More common symptoms of acute star fruit intoxication were nausea, vomiting, and abdominal and back pain, followed by low urine output and high serum creatinine over hours to days. Urinary analysis of all patients demonstrated oxalate crystals. Histopathologic examination of renal tissues of all 4 patients revealed acute tubular damage with calcium oxalate crystals, interstitial edema, and inflammatory cellular infiltration. The presence of calcium oxalate crystals was further confirmed with the brilliant birefringence seen under polarized light. Two patients needed intermittent hemodialysis over a week owing to oliguria and uremia. The other 2 patients did not require hemodialysis and had improvement of renal function with supportive treatment. All had high renal function on discharge but were back to normal within a month. This study highlights AKI as a serious complication of star fruit ingestion. The type and quantity of star fruit ingested and some patient factors may play a role in the pathogenesis of AKI. Public education about this serious uncommon complication is important.

Authors+Show Affiliations

Nephrology Unit, Teaching Hospital, Karapitiya, Sri Lanka.Nephrology Unit, Teaching Hospital, Karapitiya, Sri Lanka.Nephrology Unit, Teaching Hospital, Karapitiya, Sri Lanka.Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka. Electronic address: kosalagadw83@gmail.com.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

33518496

Citation

Herath, Nalaka, et al. "Acute Kidney Injury Following Star Fruit Ingestion: a Case Series." Wilderness & Environmental Medicine, vol. 32, no. 1, 2021, pp. 98-101.
Herath N, Kodithuwakku G, Dissanayake T, et al. Acute Kidney Injury Following Star Fruit Ingestion: A Case Series. Wilderness Environ Med. 2021;32(1):98-101.
Herath, N., Kodithuwakku, G., Dissanayake, T., Rathnathunga, N., & Weerakoon, K. (2021). Acute Kidney Injury Following Star Fruit Ingestion: A Case Series. Wilderness & Environmental Medicine, 32(1), 98-101. https://doi.org/10.1016/j.wem.2020.11.003
Herath N, et al. Acute Kidney Injury Following Star Fruit Ingestion: a Case Series. Wilderness Environ Med. 2021;32(1):98-101. PubMed PMID: 33518496.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute Kidney Injury Following Star Fruit Ingestion: A Case Series. AU - Herath,Nalaka, AU - Kodithuwakku,Gathika, AU - Dissanayake,Tharaka, AU - Rathnathunga,Neelakanthi, AU - Weerakoon,Kosala, Y1 - 2021/01/29/ PY - 2020/05/10/received PY - 2020/11/10/revised PY - 2020/11/12/accepted PY - 2021/2/2/pubmed PY - 2021/4/14/medline PY - 2021/2/1/entrez KW - Averrhoa carambola KW - acute tubular damage KW - calcium oxalate KW - nephrotoxic SP - 98 EP - 101 JF - Wilderness & environmental medicine JO - Wilderness Environ Med VL - 32 IS - 1 N2 - Star fruit (Averrhoa carambola) is a popular fruit in many tropical countries, including Sri Lanka. It is rich in oxalic acid, which is nephrotoxic in higher concentrations. The development of both acute (AKI) and chronic kidney injury after oxalate nephropathy is often underrecognized. Here we discuss the risk factors, clinical features, treatment, and outcomes of 4 patients who developed AKI after star fruit ingestion. Baseline clinical characteristics, the amount of star fruit ingested, clinical presentation, investigation, and outcome of the patients (ages 28, 50, 54, and 55 y; all male) were traced. More common symptoms of acute star fruit intoxication were nausea, vomiting, and abdominal and back pain, followed by low urine output and high serum creatinine over hours to days. Urinary analysis of all patients demonstrated oxalate crystals. Histopathologic examination of renal tissues of all 4 patients revealed acute tubular damage with calcium oxalate crystals, interstitial edema, and inflammatory cellular infiltration. The presence of calcium oxalate crystals was further confirmed with the brilliant birefringence seen under polarized light. Two patients needed intermittent hemodialysis over a week owing to oliguria and uremia. The other 2 patients did not require hemodialysis and had improvement of renal function with supportive treatment. All had high renal function on discharge but were back to normal within a month. This study highlights AKI as a serious complication of star fruit ingestion. The type and quantity of star fruit ingested and some patient factors may play a role in the pathogenesis of AKI. Public education about this serious uncommon complication is important. SN - 1545-1534 UR - https://www.unboundmedicine.com/medline/citation/33518496/Acute_Kidney_Injury_Following_Star_Fruit_Ingestion:_A_Case_Series_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1080-6032(20)30210-6 DB - PRIME DP - Unbound Medicine ER -