Acute kidney injury as a complication of biribiri<i>(Averrhoa bilimbi)</i>fruit juice excessive ingestion

Paschoalin, Raphael; Jesus, Luana Andrade Santos de; Paschoalin, Nathália Pereira; Carvalho, Túlio Coelho; Silva, Cassiano Augusto Braga da; Neto, Miguel Moysés

doi:10.5935/0101-2800.20140078

Cited by 2 publications

(4 citation statements)

References 12 publications

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“…In 2013, Bakul et al [ 11 ] described 10 cases of acute intoxication and oxalate-induced AKI due to the ingestion of Averrhoa bilimbi juice. A similar case has been reported in Brazil in 2014, involving a patient with previously normal kidney function who developed AKI after the ingestion of bilimbi fruit juice under fasting conditions [ 12 ]. The mechanisms of bilimbi-related nephrotoxicity are the same as those related to star fruit consumption.…”

Section: Introductionsupporting

confidence: 58%

“…This case had a similar course to that reported in CKD patients following star fruit ingestion regarding time of onset for hiccups followed by a decrease in consciousness [ 6 , 13 ]. Hematuria may be explained by oxalate deposits in the renal tubules, as previously hypothesized [ 12 ]. We cannot affirm that the hemodynamic instability experienced by the patient since the first hemodialysis session was also caused by the exogenous intoxication.…”

Section: Discussionmentioning

confidence: 78%

“…The toxicity associated with the consumption of bilimbi fruit seems to be a rare event, since we did not find any other case in the literature. However, in a recent report [ 12 ] of AKI associated with the ingestion of bilimbi fruit juice, the patient also experienced intractable hiccups, and the hypothesis that the symptom was caused by a neurotoxin similar to caramboxin was not ruled out.…”

Section: Discussionmentioning

confidence: 99%

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Neurotoxicity following the Ingestion of Bilimbi Fruit (Averrhoa bilimbi) in an End-Stage Renal Disease Patient on Hemodialysis

Caetano¹,

Sá²,

Faleiros³

et al. 2017

Case Rep Nephrol Dial

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Introduction: The toxic effects of the ingestion of star fruit (Averrhoa carambola) in chronic kidney disease patients are well described in the literature. Recently, the compound caramboxin has been isolated, explaining the mechanisms of its neurotoxicity. Bilimbi fruit belongs to the family Oxalidaceae, Averrhoa bilimbi species, and exhibits similar biochemical characteristics to star fruit. Objective: To report the case of a patient with chronic kidney disease who developed a seizure disorder after the ingestion of bilimbi fruit. Case Report: A 69-year-old man with chronic kidney disease on hemodialysis therapy had intractable hiccups, myoclonus, and generalized tonic-clonic seizures after the consumption of a moderate amount of bilimbi fruit. The electroencephalogram showed a pattern of seizure disorder despite the use of anticonvulsant drugs. Renal replacement therapy was maintained during the whole period and prescribed according to the patient’s hemodynamic status. Despite showing clinical resolution of the seizure disorder, the patient died on the 27th day of hospitalization for infectious complications. Conclusions: The neurologic status without any other known cause and with clear temporal association with the ingestion of the fruit suggests the diagnosis of neurotoxicity. We propose the hypothesis that the bilimbi fruit has neurotoxic effects similar to those exhibited by the star fruit.

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Section: Introductionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Neurotoxicity following the Ingestion of Bilimbi Fruit (Averrhoa bilimbi) in an End-Stage Renal Disease Patient on Hemodialysis

Caetano¹,

Sá²,

Faleiros³

et al. 2017

Case Rep Nephrol Dial

View full text Add to dashboard Cite

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“…Biri-biri has a high oxalic acid content and its consumption is linked to a high risk of developing acute renal failure due to deposition of calcium oxalate crystals in the renal tubules. Paschoalin et al, (2014) [70] reported in a case study, acute kidney injury associated with lumbar pain, hiccups, and diarrhea in a 50-year-old hypertensive patient with normal kidney function who consumed a large amount of biri-biri juice after fasting to treat hypertension. Thus, between the evaluated Amazonian fruit pulps by us, only the intake of biri-biri pulp showed risks of liver and kidney dysfunction in rats.…”

Section: Resultsmentioning

confidence: 99%

Physicochemical Properties and Effects of Fruit Pulps from the Amazon Biome on Physiological Parameters in Rats

et al. 2021

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This study aimed to analyze the physicochemical characteristics and the effects of Amazonian pulp fruits consumption, such as araçá-boi (Eugenia stipitata), abiu grande (Pouteria caimito), araticum (Annona crassiflora), biri-biri (Averrhoa bilimbi L.), and yellow mangosteen (Garcinia xanthochymus), on hematologic, metabolic, renal, and hepatic function parameters in Wistar rats (n = 10 rats/group). The pulp of abiu had the highest levels of soluble solids, sugars, and pH. Biri-biri pulp had the highest levels of ascorbic acid and total titratable acidity, and a low pH. The araticum pulp had higher (p ≤ 0.05) ash content, total phenolic compounds, and antioxidant activity than the pulp of other analyzed fruits. No significant increase in hematocrit, nor reduction of blood glucose, plasma cholesterol, and serum levels of glutamic-pyruvic transaminase (TGP), creatinine, and urea was observed in experimental groups relative to the control group of rats after the consumption of fruits pulp. The intake of abiu and araticum pulps promoted a significant reduction (p ≤ 0.05) in total leukocytes of the experimental groups as compared to the control group and only the intake of araticum significantly increased (p ≤ 0.05) triglyceride blood levels in rats (99.50 mg/dL). The regular consumption of biri-biri pulp for 30 days significantly (p ≤ 0.05) increased serum glutamic-oxaloacetic transaminase (TGO) levels in rats (116.83 U/L) compared to the control group (98.00 U/L). More researches are needed to generate knowledge about these promising Amazonian fruits, supporting the native fruit production, in addition to promoting health in the population and sustainability in the Amazon region.

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Acute kidney injury as a complication of biribiri(Averrhoa bilimbi)fruit juice excessive ingestion

Cited by 2 publications

References 12 publications

Neurotoxicity following the Ingestion of Bilimbi Fruit (Averrhoa bilimbi) in an End-Stage Renal Disease Patient on Hemodialysis

Neurotoxicity following the Ingestion of Bilimbi Fruit (Averrhoa bilimbi) in an End-Stage Renal Disease Patient on Hemodialysis

Physicochemical Properties and Effects of Fruit Pulps from the Amazon Biome on Physiological Parameters in Rats

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