Effects of carambola consumption (Averrhoa carambola) in Acute Kidney Injury
DOI:
https://doi.org/10.33448/rsd-v12i7.42807Keywords:
Averrhoa; Averrhoa carambola; Acute kidney injury; Oxalic acid.Abstract
Carambola (Averrhoa carambola) is a fruit that belongs to the Oxalidaceae family, being widely consumed in Asia and Central and South America, besides, its leaves are also used for their medicinal properties. However, carambola contains oxalic acid and caramboxin in its composition, which can cause nephrotoxicity, being a risk for those who ingest the fruit. This study aims to describe and discuss the effects of star fruit consumption in previously healthy patients and the occurrence of acute kidney injury. This is a narrative review, in which the databases of Scielo, PubMed and Google Scholar were used to support the present study, including 7 articles which demonstrate that, although the fruit has proteins, lipids, carbohydrates, fibers, water, vitamins and nutrients in its composition, it can cause nephrotoxicity due to oxalic acid, leading to acute kidney injury. Furthermore, it was verified that the sour carambola contains more oxalate than the sweet fruit, and the lethal dose ranges from 2 to 30g. Therefore, even though it appears to be a harmless fruit, it can lead to the development of acute nephropathy due to excessive ingestion of oxalic acid and caramboxin contained in it, requiring investigation in patients who present with acute kidney injury, with no apparent etiology.
References
Abeysekera, R. A., Wijetunge, S., Nanayakkara, N., Wazil, A. W. M., Ratnatunga, N. V. I., 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(1). https://doi.org/10.1186/s13104-015-1640-8
Ananna, M. A., Hasan, R., Samadl, T., Abdur Rahim, M., Erfanur Rafmanl, M., Mohsinul Haquel, W., Bilhhl Hasna Fahmima Hoque, M., Aftoz, F., Rahat Afroz, S., & Mitrat Sarwar Iqbalt, P. (2014). Acute Kidney Injury Due to Star Fruit Ingestion: A Case Report.
Avinash, P., Swapneel, K., Darshana, P., & Anita, P. (2012). A Comprehensive Review of An Important Medicinal Plant – Averrhoa carambola L. Pharmacognosy Communications, 2(2), 13–17. https://doi.org/10.5530/pc.2012.2.3
Babu, K. N., Minoo, D., Tushar, K. V., & Ravindran, P. N. (2006). Carambola. In Handbook of Herbs and Spices (Vol. 3, pp. 257–269). Elsevier Ltd. https://doi.org/10.1533/9781845691717.3.257
Barbosa, I. V., Teixeira, I. D. S., Carvalho, T. D. de, & Marques, M. S. (2021). Nefrotoxicidade e Neurotoxicidade Associadas ao Consumo da Averrhoa bilimbi e Averrhoa carambola: Uma Revisão Integrativa / Nephrotoxicity and Neurotoxicity associated with the Consumption of Averrhoa bilimbi and Averrhoa carambola: An Integrative Review. ID on Line. Revista de Psicologia, 15(58), 154–166. https://doi.org/10.14295/idonline.v15i58.3300
Barman, A. K., Goel, R., Sharma, M. & Mahanta, P. J. (2016). Acute kidney injury associated with ingestion of star fruit: Acute oxalate nephropathy. Indian J. Nefrology, 26(6), 446-448.
Chen, C. L., Fang, H. C., Chou, K. J., Wang, J. S., & Chung, H. M. (2001). Acute oxalate nephropathy after ingestion of star fruit. American Journal of Kidney Diseases, 37(2), 418–422. https://doi.org/10.1053/ajkd.2001.21333
Choon-Bing, C., Sun, C. K., Tsui, H. W., Yang, P. J., Lee, K. H., Hsu, C. W., & Tsai, I. T. (2017). Association of renal function and symptoms with mortality in star fruit (Averrhoa carambola) intoxication. In Clinical Toxicology (Vol. 55, Issue 7, pp. 624–628). Taylor and Francis Ltd. https://doi.org/10.1080/15563650.2017.1314490
Fang, H. C., Lee, P. T., Lu, P. J., Chen, C. L., Chang, T. Y., Hsu, C. Y., Chung, H. M., & Chou, K. J. (2008). Mechanisms of star fruit-induced acute renal failure. Food and Chemical Toxicology, 46(5), 1744–1752. https://doi.org/10.1016/j.fct.2008.01.016
Ferrara, L. (2018). Averrhoa carambola Linn: Is It Really a Toxic Fruit? Journal of Chromatography A, 5(1), 2–5.https://doi.org/10.1016/j.chroma.2003.09.055
Herath, N., Kodithuwakku, G., Dissanayake, T., Rathnathunga, N., & Weerakoon, K. (2021). Acute Kidney Injury Following Star Fruit Ingestion: A Case Series. Wilderness and Environmental Medicine, 32(1), 98–101. https://doi.org/10.1016/j.wem.2020.11.003
Konta, T., Yamaoka, M., Tanida, H., Matsunaga, T., & Tomoike, H. (1998). Acute Renal Failure due to Oxalate Ingestion. Intern Med., 37(9), 762-65.
Luan, F., Peng, L., Lei, Z., Jia, X., Zou, J., Yang, Y., He, X., & Zeng, N. (2021). Traditional Uses, Phytochemical Constituents and Pharmacological Properties of Averrhoa carambola L.: A Review. In Frontiers in Pharmacology (Vol. 12). Frontiers Media S.A. https://doi.org/10.3389/fphar.2021.699899
Neto, M. M., Silva, G. E. B., Costa, R. S., Neto, O. M. V., Garcia-Cairasco, N., Lopes, N. P., Haendchen, P. F. C., Silveira, C., Mendes, A. R., Filho, R. R., & Dantas, M. (2009). Star fruit: Simultaneous neurotoxic and nephrotoxic effects in people with previously normal renal function. NDT Plus, 2(6), 485–488. https://doi.org/10.1093/ndtplus/sfp108
Roberti, A., de Sousa, M. F., dos Santos, M. R., Cavalcante, I. de O., De Oliveira, I. R., De Oliveira, J. C., & De Sousa, J. G. D. (2014). Lesão renal aguda por consumo de carambola: relato de caso e revisão da literatura. Revista da Sociedade Brasileira de Clínica Médica, 12(2), 1-6.
Rother, E. T. (2007). Revisão sistemática X revisão narrativa. Acta Paulista de Enfermagem, 20(2), v–vi. https://doi.org/10.1590/S0103-21002007000200001
Scaranello, K. L., Alvares, V. R. de C., Carneiro, D. M. Q., Barros, F. H. S., Gentil, T. M. S., Thomaz, M. J., Pereira, B. J., Pereira, M. B., Leme, G. M., Diz, M. C. E., & Laranja, S. M. R. (2014a). Case Report. Star fruit as a cause of acute kidney injury. Jornal Brasileiro de Nefrologia, 36(2), 246–249. https://doi.org/10.5935/0101-2800.20140036
Scheid, C. R., Koul, H. K., Kennington, L., Hill, W. A., & Luber-Narod, J. (1995). Scanning Microscopy Scanning Microscopy Oxalate-Induced Damage to Renal Tubular Cells Oxalate-Induced Damage to Renal Tubular Cells. https://digitalcommons.usu.edu/microscopyhttps://digitalcommons.usu.edu/microscopy/vol9/iss4/15
Yasawardene, P., Jayarajah, U., De Zoysa, I., & Seneviratne, S. L. (2020). Mechanisms of star fruit (Averrhoa carambola) toxicity: A mini-review. In Toxicon (Vol. 187, pp. 198–202). Elsevier Ltd. https://doi.org/10.1016/j.toxicon.2020.09.010
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Stephanie Ballatore Holland Lins; João Victor Lustosa Torres Lopes; Luane Tavares de Oliveira; Luiz Felipe Neves Frazão; Annelysa Vitória Souza Ramalho; Steffany de Souza Vale; Samuel de Jesus Santos
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
