ISSN: 2251-8363    eISSN: 2251-8819  
J Nephropathol. 2018;7(4):296-300.

Case Series

A case series on Averrhoa bilimbi induced acute oxalate nephropathy; an experience from a tertiary center in Kerala, India

Zuhara Shemin Kooloth Mahamoodh 1 * , Seethalekshmy Nalumackal Vijayan 2, Annie Jojo 2

1 Department of Pathology, MES Medical College, Kerala University of Health Sciences, Perinthalmanna, Kerala, India
2 Department of Pathology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
*Corresponding author: Zuhara Shemin, Email: Email:


Background: Averrhoa bilimbi is a commonly used fruit in South India for various home preparations and as a traditional remedy for hypercholesterolemia and hypertension. As it belongs to Oxalidaceae family, fruit has high oxalate content, causing calcium oxalate crystal deposition in renal tubules, resulting in acute oxalate nephropathy (AON) when consumed in large quantities.

Case Series: We present a series of 24 patients from 11 hospitals in the State of Kerala who developed acute renal failure after some days of intake of Irumban puli fruit juice. Seven patients needed hemodialysis while the other three improved with conservative management.

Conclusions: We conclude that it is not safe to consume high oxalate containing fruits, especially in concentrated forms, that too in large quantities.

Implication for health policy/practice/research/medical education:

Irumban Puli (Averrhoa bilimbi) is commonly used as an ingredient of various South Indian dishes. It is also used in various other South East Asian countries for the indigenous method of treatment of diseases like hypertension, diabetes and hypercholesterolemia. Consumption of highly concentrated fruit juice can lead to acute renal failure due to acute tubular necrosis. The high oxalate content leads to Intra-tubular oxalate crystal deposition and renal failure. Hence, we conclude that it is not safe to consume such fruits with high oxalate content, especially in concentrated forms.

Please cite this paper as: Mahamoodh ZSK, Nalumackal Vijayan S, Jojo A. A case series on Averrhoa bilimbi induced acute oxalate nephropathy; an experience from a tertiary center in Kerala, India. J Nephropathol. 2018;7(4):296-300. DOI: 10.15171/ jnp.2018.59.

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Submitted: 08 Feb 2018

Accepted: 28 Apr 2018
First published online: 19 May 2018
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