Star Fruit induced Acute Kidney Injury

Starfruit, also known as Averrhoa carambola L., is widely available in tropical countries. 

An interesting case of acute kidney injury (AKI) appears in the ward today with unknown etiology. Investigation was done but to no avail. Out of a moment, star fruit pop in my mind. And tadaaaaaa, the patient admitted that few star fruits was eaten. Problem solved!

Star fruit is traditionally used for its hypoglycemic effect in diabetes patient. Star fruit is high in oxalates and it is believed that the high content of oxalate crystals may lead to neuropathy by inducing self-destruction @ apoptosis of renal cells.

Over ingestion of star fruits can lead to onset of symptoms varying from hiccups, vomiting to mental confusion or seizure, which in some cases can be fatal. 

So, be aware of that, especially when patient with renal impairment mentioned that they plan to consume starfruit, remember to advice them on the precaution.

References 

Lee K. G. (2012). Star fruit intoxication with acute kidney injury. Clinical medicine (London, England), 12(5), 494. https://doi.org/10.7861/clinmedicine.12-5-494

Muthu N., Lee S.Y., Phua K.K., Bhore S.J. Nutritional, medicinal and toxicological attributes of star-fruits (Averrhoa Carambola L.): a review. Bioinformation. 2016;12:420–4. https://doi.org/10.6026/97320630012420.

Abeysekera, R. A., Wijetunge, S., Nanayakkara, N., Wazil, A. W., Ratnatunga, N. V., Jayalath, T., & Medagama, A. (2015). Star fruit toxicity: a cause of both acute kidney injury and chronic kidney disease: a report of two cases. BMC research notes, 8, 796. https://doi.org/10.1186/s13104-015-1640-8