Acute oxalate nephropathy due to ‘Averrhoa bilimbi’ fruit juice ingestion
A 38-year-old man, who was working abroad and came to India on a vacation, underwent a health check up, which showed normal renal functions and hypercholesterolemia. He consumed a glass of I. puli fruit juice daily for 4 days for control of hypercholesterolemia. After 4 days, the patient developed abdominal discomfort, nausea, and loss of appetite. He presented to our center with the above-mentioned symptoms; he had normal urine output. On examination, the patient was conscious, oriented, blood pressure 150/90 mmHg; he had no edema, and his systems were normal. Investigations showed severe renal failure with serum creatinine of 6.4 mg/dl, with normal hemogram and liver function tests; urine analysis showed no albuminuria, and microscopy showed oxalate crystals. Ultrasonogram of abdomen was normal. The patient underwent two sessions of hemodialysis, following which a left percutaneous kidney biopsy was done. Kidney biopsy showed acute tubular necrosis with many polarizable fractured crystals in the tubular lumina (calcium oxalate crystals) [Figure and ]. 24-h urinary oxalate was 60 mg/day. The oxalate content of the fruit was 25.1 mg per 100 g of the fruit, when analyzed in our lab by spectrophotometry method. He was on hemodialysis for 10 days. His renal functions improved to normal in 6 weeks (serum creatinine: 0.9 mg/dl).