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

Abstract

BackgroundStar 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 presentationThe 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.ConclusionThese 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1640-8) contains supplementary material, which is available to authorized users.

A preliminary study on the effects of star fruit consumption on antioxidant and lipid status in elderly Thai individuals

“…Previous evidence suggested that the adverse effects on kidney function may be of concern, especially in patients with uremic condition43 or chronic kidney disease 44. However, results from the 27 elderly people in this study showed that BUN and creatinine levels in three experiments were within the reference range with no statistically significant difference (Table 1).…”

Star fruit nephrotoxicity: a case series and literature review

“…Crystalline deposits Supportive. Full recovery 1/1 Half a kilogram of starfruit 2015 Abeysekera et al [ 32 ] Sri Lanka 2 Normal (1), CKD- serum creatinine 133 micromol/l (eGFR 50.6 ml/min) (1) – Oxalate nephropathy seen in both. Acute interstitial nephritis (1) Acute on chronic interstitial nephritis (1) Prednisolone in patient with acute interstitial nephritis.…”

“…A case of chronic kidney disease attributable to frequent ingestion of star fruit was recently reported from Sri Lanka [ 32 ]. It has been suggested that chronic kidney disease may result from calcium oxalate induced interstitial inflammation, fibrosis and nephron loss.…”

The Prevalence of Obesity among Subjects with Chronic Kidney Disease – Cross Sectional Study of Sri Lanka Population

“…Multiple aetiological factors have been postulated for CKDu including chronic exposure to Cadmium, Lead, Arsenic and Ochratoxin-A through food chain [8,9,[13][14][15][16]. However, increasing CKDu may be multifactorial and obesity may also be a contributing factor -that has not been systematically studied to date [17].…”