Community Acquired Acute Kidney Injury from Edible Agents: Report from a Developing Country, Bangladesh

Abstract

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.

Risk factors for acute kidney injury among patients with chikungunya: a multi-center experience from the 2017 chikungunya outbreak in Dhaka, Bangladesh

“…Discussion AKI is common in community and in hospital settings and may have diverse aetiology. [9][10][11][12] Chikungunya viral infections have few but life threating acute complications like encephalitis 13 and cardiomyopathy 14 , but nephritis 4 is rarely reported. Infection associated glomerulonephritis and AKI is common in tropics [15][16][17] , but as an aetiology, chikungunya 3,18 is occasionally mentioned.…”

Concurrent acute kidney injury and acute hepatitis resulting from raw fish gallbladder ingestion: a preventable cause of community acquired organ damage

“…8 Cyprinol and related compounds in fish gall bladder are thought to be the cause of acute tubular necrosis in such cases. 9 Furthermore, frequent vomiting, diarrhea and insufficient fluid intake can worsen renal failure due to significantly decreased intravascular fluid volume. 2 AKI after fish gall bladder ingestion has a variable prognosis.…”

“…However, death may result from fulminant hepatic failure. 7 Treatment comprises of hemodialysis and supportive management 9 and most of the reported cases till date have undergone hemodialysis in view of renal failure. The patient in the reported case also responded to the same line of management.…”

Is Excessive Intake of Kamias Fruit (Averrhoa bilimbi) Bad for Your Heath? A Case Report and Review

“…Oxalic acid crystals stimulate connective tissue growth factor genes in the renal tubular cells leading to interstitial fibrosis [2]. Absence of calcium oxalate crystals on urinalysis or normal 24-hour urine oxalate level does not rule out acute oxalate nephropathy [3]. Almost all of reported AKI cases from acute oxalate nephropathy occurred after consuming excessive amounts of Averrhoa bilimbi in the form of juice.…”