RESUMEN
Star fruit toxicity has been hugely described in patients with chronic kidney disease, either on conservative or renal replacement therapy. This is a case report of a man, without prior kidney or neurological dysfunction, who appeared to develop nephrotoxicity and neurotoxicity less than 12 hours after drinking concentrated star fruit juice (approximately 20 units of the fruit). He received timely renal replacement therapy and renal function fully recovered after discharge.
Asunto(s)
Lesión Renal Aguda/inducido químicamente , Averrhoa/efectos adversos , Jugos de Frutas y Vegetales/efectos adversos , Síndromes de Neurotoxicidad/etiología , Lesión Renal Aguda/terapia , Adulto , Humanos , Masculino , Terapia de Reemplazo RenalRESUMEN
Several reports have discussed the neurotoxic effects of star fruit (Averrhoa carambola) in patients with chronic kidney disease (CKD). There is also some evidence highlighting the potentially harmful effects on patients with apparently normal renal function, who after consuming this fruit, developed acute renal injury. We performed a systematic review of the literature in the two main global databases (PubMed and Embase) as well as in Lilacs, for Latin American publications. We also included case reports, case series, or review articles which presented individual patient data. Animal or in vitro studies were excluded. We initially screened 259 references, of which 42 were selected for full-text review and 26 were finally selected for data extraction. A total of 123 patients from eight countries were documented: Brazil, with 47 cases, had the highest reported incidence, followed by Taiwan (36), Bangladesh (20), China and France (8 each), Sri Lanka (2), and Thailand and Colombia (1 each); 28 (22%) of the patients died. Despite the relatively low frequency of star fruit consumption, it has become a global issue. Patients with already diagnosed CKD are the obvious target for preventive measures, but persons with undiagnosed kidney conditions could also be at risk.
Asunto(s)
Lesión Renal Aguda/epidemiología , Averrhoa/efectos adversos , Frutas/efectos adversos , Riñón/fisiopatología , Insuficiencia Renal Crónica/epidemiología , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/fisiopatología , Lesión Renal Aguda/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndromes de Neurotoxicidad/epidemiología , Síndromes de Neurotoxicidad/fisiopatología , Recuperación de la Función , Diálisis Renal , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/terapia , Medición de Riesgo , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: Star fruit (SF) is a popular fruit, commonly cultivated in many tropical countries, that contains large amount of oxalate. Acute oxalate nephropathy and direct renal tubular damage through release of free radicals are the main mechanisms involved in SF-induced acute kidney injury (AKI). The aim of this study was to evaluate the protective effect of N-acetylcysteine (NAC) on SF-induced nephrotoxicity due to its potent antioxidant effect. MATERIALS AND METHODS: Male Wistar rats received SF juice (4 mL/100 g body weight) by gavage after a 12 h fasting and water deprivation. Fasting and water deprivation continued for 6 h thereafter to warrant juice absorption. Thereafter, animals were allocated to three experimental groups: SF (n = 6): received tap water; SF + NAC (n = 6): received NAC (4.8 g/L) in drinking water for 48 h after gavage; and Sham (n = 6): no interventions. After 48 h, inulin clearance studies were performed to determine glomerular filtration rate. In a second series of experiment, rats were housed in metabolic cages for additional assessments. RESULTS: SF rats showed markedly reduced inulin clearance associated with hyperoxaluria, renal tubular damage, increased oxidative stress and inflammation. NAC treatment ameliorated all these alterations. Under polarized light microscopy, SF rats exhibited intense calcium oxalate birefringence crystals deposition, dilation of renal tubules and tubular epithelial degeneration, which were attenuate by NAC therapy. CONCLUSIONS: Our data show that therapeutic NAC attenuates renal dysfunction in a model of acute oxalate nephropathy following SF ingestion by reducing oxidative stress, oxaluria, and inflammation. This might represent a novel indication of NAC for the treatment of SF-induced AKI.