A case series on Averrhoa bilimbi induced acute oxalate nephropathy; an experience from a tertiary center in Kerala, India

Zuhara Shemin Kooloth Mahamoodh,Annie Jojo,Seethalekshmy Nalumackal Vijayan

doi:10.15171/jnp.2018.59

Abstract

Background: Averrhoa bilimbi is a commonly used fruit in South India for various home preparations and as a traditional remedy for hypercholesterolemia and hypertension. As it belongs to Oxalidaceae family, fruit has high oxalate content, causing calcium oxalate crystal deposition in renal tubules, resulting in acute oxalate nephropathy (AON) when consumed in large quantities. Case Series: We present a series of 24 patients from 11 hospitals in the State of Kerala who developed acute renal failure after some days of intake of Irumban puli fruit juice. Seven patients needed hemodialysis while the other three improved with conservative management. Conclusions: We conclude that it is not safe to consume high oxalate containing fruits, especially in concentrated forms, that too in large quantities.

Highlights

Averrhoa bilimbi is a commonly used fruit in South India for various home preparations and as a traditional remedy for hypercholesterolemia and hypertension
Calcium oxalate crystals are deposited in renal tubules and results in acute renal failure
We present a series of 24 cases from 11 different hospitals in the state of Kerala, during the study period 2010-2013, who developed acute oxalate nephropathy (AON) after consumption of I. puli juice

Summary

Introduction

Averrhoa bilimbi is a commonly used fruit in South India for various home preparations and as a traditional remedy for hypercholesterolemia and hypertension As it belongs to Oxalidaceae family, fruit has high oxalate content, causing calcium oxalate crystal deposition in renal tubules, resulting in acute oxalate nephropathy (AON) when consumed in large quantities. Case Series: We present a series of 24 patients from 11 hospitals in the State of Kerala who developed acute renal failure after some days of intake of Irumban puli fruit juice. Irumban puli (Averrhoa bilimbi), belonging to the same genus as A. carambola, has high oxalic acid content It has commonly seen in South India and is used in various preparations. We present a series of 24 cases from 11 different hospitals in the state of Kerala, during the study period 2010-2013, who developed acute oxalate nephropathy (AON) after consumption of I. puli juice

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