Acute oxalate nephropathy due to ‘Averrhoa bilimbi’ fruit juice ingestion
A 57-year-old man, known to have type 2 diabetes mellitus (on diet control) and dyslipidemia (on statins) presented to us with a history of anorexia, nausea, and fatigue for 2 weeks after intake of I. puli fruit juice for 5 days; he was oliguric. He had a normal hemogram, with serum creatinine: 9.3 mg/dl, serum cholesterol: 180 mg/dl. Urine analysis showed 1+ Protein, and microscopic examination of the urine sample showed plenty of oxalate crystals. He was initiated on hemodialysis and subsequently underwent a left percutaneous kidney biopsy which showed acute tubular necrosis with intra tubular calcium oxalate crystals. He needed six sessions of hemodialysis. His renal functions became normal in about 5 weeks’ time.\nSimilar cases have been reported in other hospitals of Kerala. All the patients had history of consuming I. puli juice and developed renal failure. None of the patients had history of renal failure before consuming the fruit juice. The details of these ten patients are given in . All the patients were male, age ranging from 38 to 72 years. Six patients had pre-existing problems like diabetes mellitus or hypertension. Eight out of 10 patients had plenty of oxalate crystals in urine; all the patients had severe renal failure with serum creatinine ranging from 5.5 to 12.3 mg/dl. Seven patients required hemodialysis in view of severe renal failure; the remaining three patients were treated conservatively and renal functions returned to normal. Kidney biopsy was performed in seven patients. All the patients showed acute tubular necrosis with polarizable tubular crystals consistent with oxalate crystals []. The time taken for Serum creatinine to reach the normal level ranged from 2 to 6 weeks.