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Nephrotoxicity and neurotoxicity following star fruit (Averrhoa carambola) ingestion: a narrative review.
Trans R Soc Trop Med Hyg. 2021 09 03; 115(9):947-955.TR

Abstract

In recent times, star fruit (Averrhoa carambola) nephrotoxicity and neurotoxicity have been increasingly reported, both in individuals with pre-existing renal disease and those with previously normal renal function. We summarise the clinical findings of star fruit toxicity in humans and outline the important pathogenetic insights provided by animal studies. Google Scholar, EMBASE, Scopus and PubMed were searched from 1995 through July 2020 for case reports/series on renal or neurological manifestations of star fruit toxicity in humans and mechanisms of star fruit toxicity in animal studies. Ten case series and 28 case reports in humans (total number of individuals=136) were included and 8 animal studies were analysed. Ninety-four (69.1%) patients had prior renal impairment. Renal histology showed acute oxalate nephropathy with tubulointerstitial nephritis or tubular necrosis. Neurotoxicity manifestations ranged from hiccups to status epilepticus. Oxalate and caramboxin are considered the main substances causing nephrotoxicity and neurotoxicity. Caramboxin inhibits GABA binding and activates the glutamatergic receptors. Haemodialysis improved outcomes in neurotoxicity. Nephrotoxicity and neurotoxicity need to be looked for with star fruit toxicity, both in individuals with abnormal or normal renal function. Once star fruit intoxication is identified, early renal replacement therapy should be considered. Further studies on the mechanisms of star fruit toxicity are needed.

Authors+Show Affiliations

Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 08, Sri Lanka.Postgraduate Institute of Medicine, University of Colombo, 160, Prof. Nandadasa Kodagoda Mawatha, Colombo 07, Sri Lanka.Department of Surgery, Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 08, Sri Lanka.Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals, Colombo 02, Sri Lanka.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

33693950

Citation

Yasawardene, Pamodh, et al. "Nephrotoxicity and Neurotoxicity Following Star Fruit (Averrhoa Carambola) Ingestion: a Narrative Review." Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 115, no. 9, 2021, pp. 947-955.
Yasawardene P, Jayarajah U, De Zoysa I, et al. Nephrotoxicity and neurotoxicity following star fruit (Averrhoa carambola) ingestion: a narrative review. Trans R Soc Trop Med Hyg. 2021;115(9):947-955.
Yasawardene, P., Jayarajah, U., De Zoysa, I., & Seneviratne, S. L. (2021). Nephrotoxicity and neurotoxicity following star fruit (Averrhoa carambola) ingestion: a narrative review. Transactions of the Royal Society of Tropical Medicine and Hygiene, 115(9), 947-955. https://doi.org/10.1093/trstmh/trab026
Yasawardene P, et al. Nephrotoxicity and Neurotoxicity Following Star Fruit (Averrhoa Carambola) Ingestion: a Narrative Review. Trans R Soc Trop Med Hyg. 2021 09 3;115(9):947-955. PubMed PMID: 33693950.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nephrotoxicity and neurotoxicity following star fruit (Averrhoa carambola) ingestion: a narrative review. AU - Yasawardene,Pamodh, AU - Jayarajah,Umesh, AU - De Zoysa,Ishan, AU - Seneviratne,Suranjith L, PY - 2020/09/20/received PY - 2021/01/19/revised PY - 2021/02/09/accepted PY - 2021/3/12/pubmed PY - 2021/10/1/medline PY - 2021/3/11/entrez KW - Averrhoa carambola KW - acute kidney injury KW - caramboxin KW - nephrotoxicity KW - neurotoxicity KW - oxalate KW - star fruit SP - 947 EP - 955 JF - Transactions of the Royal Society of Tropical Medicine and Hygiene JO - Trans R Soc Trop Med Hyg VL - 115 IS - 9 N2 - In recent times, star fruit (Averrhoa carambola) nephrotoxicity and neurotoxicity have been increasingly reported, both in individuals with pre-existing renal disease and those with previously normal renal function. We summarise the clinical findings of star fruit toxicity in humans and outline the important pathogenetic insights provided by animal studies. Google Scholar, EMBASE, Scopus and PubMed were searched from 1995 through July 2020 for case reports/series on renal or neurological manifestations of star fruit toxicity in humans and mechanisms of star fruit toxicity in animal studies. Ten case series and 28 case reports in humans (total number of individuals=136) were included and 8 animal studies were analysed. Ninety-four (69.1%) patients had prior renal impairment. Renal histology showed acute oxalate nephropathy with tubulointerstitial nephritis or tubular necrosis. Neurotoxicity manifestations ranged from hiccups to status epilepticus. Oxalate and caramboxin are considered the main substances causing nephrotoxicity and neurotoxicity. Caramboxin inhibits GABA binding and activates the glutamatergic receptors. Haemodialysis improved outcomes in neurotoxicity. Nephrotoxicity and neurotoxicity need to be looked for with star fruit toxicity, both in individuals with abnormal or normal renal function. Once star fruit intoxication is identified, early renal replacement therapy should be considered. Further studies on the mechanisms of star fruit toxicity are needed. SN - 1878-3503 UR - https://www.unboundmedicine.com/medline/citation/33693950/Nephrotoxicity_and_neurotoxicity_following_star_fruit__Averrhoa_carambola__ingestion:_a_narrative_review_ L2 - https://academic.oup.com/trstmh/article-lookup/doi/10.1093/trstmh/trab026 DB - PRIME DP - Unbound Medicine ER -