Acute Oxalate Nephropathy Due to Bilimbi Poisoning: A Case Report
Background: The concentrated juice made from Averrhoa bilimbi is rich in oxalic acid. It can cause acute oxalate nephropathy by blocking the tubules with calcium oxalate crystals.
Case: An elderly woman was admitted to the hospital with a history of swelling of the legs, facial puffiness, and abdominal distention. Her biochemical study revealed features of acute renal failure. She gave history of taking half liter of bilimbi juice. Renal biopsy confirmed it was a case of acute oxalic nephropathy, which made it the second case of acute oxalic nephropathy due to ingestion of bilimbi juice ever reported from Bangladesh.
Conclusion: It is not safe to consume high oxalate-containing fruits in large quantities.
2. Jha V, Parameswaran S. Community-acquired acute kidney injury in tropi¬cal countries. Nat Rev Nephrol. 2013 May;9(5):278-90.
3. Oommachan M, Khan SS. Plants in aid of family planning programme. Anc Sci Life. 1981 Jul;1(1):67-9.
4. Galvão de Lima VL, de Almeida Mélo E, dos Santos Lima L. Physicoche¬mical characteristics of bilimbi (Averrhoa bilimbi L.). Rev Bras Frutic. 2001 Aug;23(2):421-3.
5. Nair S, George J, Kumar S, Gracious N, Acute oxalate nephropathy following ingestion of Averrhoa bilimbi juice. Case Rep Nephrol. 2014;2014:240936.
6. Bakul G, Unni VN, Seethaleksmy NV, Mathew A, Rajesh R, Kurien G, et al. Acute oxalate nephropathy due to ‘Averrhoa bilimbi’ fruit juice ingestion. Indian J Nephrol. 2013 Jul;23(4):297-300.
7. Williams HE, Wandzilak TR. Oxalate synthesis, transport and the hype¬roxaluric syndromes. J Urol. 1989 Mar;141 (3 Pt 2):742-9.
8. Chlebeck PT, Milliner DS, Smith LH. Long-term prognosis in primary hype¬roxaluria type II (L-glyceric aciduria). Am J Kidney Dis. 1994 Feb;23(2):255-9.
9. Janick J, Paull RE. The encyclopedia of fruit and nuts. Wallingford: CABI Publishers; 2008. p. 575.
10. Ambili S, Subramoniam A, Nagarajan NS. Studies on the antihyperlipide¬mic properties of Averrhoa bilimbi fruit in rats. Planta Med. 2009 Jan;75(1):55- 8.
11. Neto MM, da Costa JA, Garcia-Cairasco N, Netto JC, Nakagawa B, Dantas M. Intoxication by star fruit (Averrhoa carambola) in 32 uraemic patients: treatment and outcome. Nephrol Dial Transplant. 2003 Jan;18(1):120-5.
12. Neto MM, Robl F, Netto JC. Intoxication by star fruit (Averrhoa carambola) in six dialysis patients? (Preliminary report). Nephrol Dial Transplant. 1998 Mar;13(3):570-2.
13. Billah MM, Rahman MA, Rahim MA, Swarna AT, Mitra P, Chowdhury TA, et al. Acute kidney injury following ingestion of Averrhoa bilimbi Juice. Bangla¬desh Crit Care J. 2015 Sep;3(2):71-3.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to email@example.com
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to firstname.lastname@example.org