Abstract: PUB372
Chronic Consumption of Star Fruit Causes CKD: A Novel Case Report
Session Information
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Kar, Shubharthi, Habiganj Medical College, Habiganj, Bangladesh
- Hasan, Sayful, Sylhet MAG Osmani Medical College, Sylhet, Sylhet Division , Bangladesh
- Das, Dhruba, Sylhet MAG Osmani Medical College, Sylhet, Sylhet Division , Bangladesh
- Islam, Sk Md Jaynul, Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrines and Metabolic Disorders, Dhaka, Dhaka Division, Bangladesh
Introduction
Starfruit, is a popular tropical fruit in South Asia including Bangladesh. It has potentially harmful effects on the kidneys and nervous system. Starfruit has high levels of oxalate, which is thought to be the cause of nephrotoxicity. Acute kidney injury (AKI) is also reported in previously healthy patients. A case of chronic kidney disease (CKD) believed to be caused by long-term star fruit consumption has also been reported in diabetics. We report a case of CKD after chronic ingestion of star fruit in a non diabetic. To the best of our knowledge this is the first reported case of CKD due to ingestion of star fruit in Bangladesh.
Case Description
A 38 years old male presented with on and off leg swelling for 4 months. He was normotensive, non-diabetic, non alcoholic, non smoker. He didn’t have any exertional dyspnea, chest pain, jaundice, cold intolerance, dysuria and bowel disturbances. He denied any history of taking NSAIDs. There was raised serum creatinine level which was advised by his general physician, so he was referred to nephrologist. He gave history of chronic consumption of starfruit. On repeated evaluation of renal function, serum creatinine was persistently raised for more than 3 months and it was 1.55 mg/dl. Renal biopsy was done and it revealed 14% glomeruli was globally sclerosed and interstitial fibrosis and tubular atrophy were occupying 10% of the cortical area. Some of the tubules were packed with oxalate crystal with moderate to severe acute tubular injury. Interstitium showed mixed inflammatory cell infiltration containing many eosinophil and plasma cells.
Discussion
There are a lot of case reports on AKI caused by starfruit ingestion. But, starfruit causing CKD is rare. Our patient developed CKD with no conclusive cause was identified apart from chronic starfruit consumption. Calcium oxalate is one of the most reactive crystals and it leads to interstitial fibrosis and loss of nephrons. This points validates as chronic starfruit ingestion causes CKD. Moreover, renal biopsy of this patient revealed oxalate crystal deposition in renal tubules. This finding had a strong favor on our diagnosis. To the best of our knowledge, it is the first reported case regarding this issue in Bangladesh. This case report will give an insight to rethink about this possible cause of CKD in the regions where strafruit consumption is common.