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Table 1 Summary of published case reports/ case series of star fruit neurotoxicity and nephrotoxicity

From: Star fruit nephrotoxicity: a case series and literature review

Year

Author

Country

Number of patients

Baseline renal function

Neurotoxicity

Renal biopsy

Treatment and outcome

Presence of diabetes

Type and dose of star fruit

1998

Neto et al. [10]

Brazil

6

On HD

+

N/A

HD

One death

N/A

Ingestion of 2–3 fruits or 150–200 ml of the fruit juice

2000

Chang et al. [11]

Taiwan

20

15 on HD

4 on CAPD

1 SCr 6.4 mg/dl

+

N/A

Routine RRT +/− emergency HD

8 deaths including one patient who was pre-dialytic (out of 10 with impaired consciousness)

7/20

All patients who died had eaten one to two fresh fruits.

2001

Chen et al [6]

Taiwan

2

Normal

–

Acute Oxalate Nephropathy (2/2)

HD. Recovered renal function

0/2

1.6 L and 3 L sour carombola juice

2002

Chang et al. [12]

Taiwan

1

CKD (Scr 4.3 mg/dl)

+

N/A

HD.

Recovered

1/1

2 star fruits

2002

Yap et al. [13] (from review)

Taiwan

3

CKD

+

N/A

HD

2 recovered. 1 died

N/A

N/A

2003

Neto et al.. [4]

Brazil

32

20 on HD

8 on PD

4 CKD on supportive care.

+

N/A

HD (conventional, daily), CRRT, IPD, symptomatic. 7 deaths

8/32

Half a fruit to 10 fruits

2003

Tse et al. [14]

Hong Kong

7

4 on CAPD

1 on HD

2 CKD- Predialyitic

+

N/A

3 intensive dialysis (PD/HD)

PD and HD initiated in pre-dialytic

All recovered

3/7

N/A

2004

Chang and Yeh [15]

Taiwan

1

HD

+

N/A

HD, phenytoin

1/1

Recovery

2005

Chen et al. [16]

Taiwan

1

CKD- predialytic

+

N/A

Two HD, followed by HP- recovered

1/1

3 star fruits

2005

Tsai et al... [17]

Taiwan

2

CKD- predialytic

+

N/A

HD, recovered

N/A

2–3 fresh fruits

2006

Niticharoenpong K et al..... [18]

Thailand

1

CKD-predialytic

+

Oxalate nephropathy

HD, partial renal recovery

N/A

N/A

2006

Wang et al. [19]

Taiwan

1

CKD- predialytic

+

N/A

HD, death

0/1

3 star fruits

2007

Wu et al. [20]

Taiwan

2

1 on HD

1 CKD V (predialytic)

+

N/A

HD followed by HP, both survived on chronic HD

1/2

1–2 star fruits

2008

Marín-Restrepo et al. [21]

Colombia

1

On HD

+

N/A

HD, recovered

N/A

N/A

2009

Chan et al. [22]

Hong Kong

1

CKD (eGFR 15 ml/min-MDRD)

+

N/A

Charcoal haemoperfusion, continuous haemofiltration, recovered eGFR 11 ml/min- MDRD)

1

2 star fruits

2009

Herbland et al. [23]

France

6

CKD

+

N/A

Two patients died Four recovered after standard

dialysis, hemofiltration, and

diafiltration

N/A

N/A

2009

Neto et al.. [3]

Brazil

5

Normal (S. Cr 79.5–106.2 micromol/l)

+

Acute oxalate nephropathy (2/2)

Full recovery with symptomatic care

N/A

12–15 fruits, 0.3- 1 l pure juice

2009

Signaté A et al. [24]

France

2

CKD-predialytic

+

N/A

Recovered with haemofiltration

N/A

N/A

2010

Auxiliadora-

Martins et al..... [25]

Brazil

1

CKD –pre-dialytic

+

N/A

HD. Died

0/1

Star fruit juice

2010

Chen et al. [26]

Taiwan

1

CKD (Serum creatinine 1.45 mg/dl)

+

N/A

HD for neurotoxicity, (Serum creatinine 1.8 mg/dl)

Recovered

1/1

1 fresh fruit

2010

Moreira et al. [27]

Brazil

1

CKD

+

N/A

HD. Died

N/A

N/A

2011

Wu et al. [28]

Taiwan

2

1 on HD

1 CKD V – predialytic

+

N/A

SLEDD-f + charcoal HP. Both remained comatose. One died

½

1–2 star fruits

2011

Su YJ [29]

Taiwan

1

Normal

–

Acute oxalate nephropathy

Supportive care. Recovered to serum creatinine 0.92 mg/dl

0/1

1 l pure juice

2012

Alessio-Alves et Al [30]

Brazil

1

On HD

+

N/A

HD. Recovered

0/1

Star fruit

2014

Scaranello et al [8]

Brazil

1

Normal

–

N/A

HD. Recovered renal function

N/A

N/A

2014

Ananna et al [31]

Banglad-esh

1

Normal

+

Acute tubular necrosis. Crystalline deposits

Supportive. Full recovery

1/1

Half a kilogram of starfruit

2015

Abeysekera et al [32]

Sri Lanka

2

Normal (1), CKD- serum creatinine 133 micromol/l (eGFR 50.6 ml/min) (1)

–

Oxalate nephropathy seen in both. Acute interstitial nephritis (1) Acute on chronic interstitial nephritis (1)

Prednisolone in patient with acute interstitial nephritis. Renal function recovered to baseline in both

2/2

4–6 star fruits (Patient CKD – on a background of regular consumption)

2015

Ananna et al [33]

Banglad-esh

20

Normal (15),

CKD (5)

+

N/A

HD (5). Of 3 with normal baseline- 3 developed CKD, 1 HD dependent.

Of baseline CKD- 1 became HD dependent

11/20

1–6 star fruits, 150 ml/500 ml juice

2017

Molina et al [34]

Peru

1

?normal

+

N/A

Urinary alkalization with potassium citrate. SCr recovered to 1.4 mg/dl

1/1

2–3 glasses of juice

2017

Wijayaratne et al

Sri Lanka

3

Normal (2), unkown(1)

+

Oxalate nephropathy (2) Acute interstitial nephritis (1)

HD (2). Prednisolone given to two patients. Both with normal baseline creatinine recovered to baseline.

3/3

3–4 star fruits. In one case recent increase in consumption to 3/day on a background of 1 daily

  1. Bold- Background normal renal function
  2. CKD chronic kidney disease, HD haemodialysis, HP Haemoperfusion, CRRT continuous renal replacement therapy, IPD intermittent peritoneal dialysis, CAPD continuous ambulatory peritoneal dialysis, SLEDD-f slow low efficiency daily diafiltration, N/A not available, + − present, −-absent
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BMC Nephrology

ISSN: 1471-2369

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