Renal catastrophe with herbal ingestion case series of nephrotoxicity with Averrhoa bilimbi ("irumban puli")

Global Summit on Nephrology, Urology and Kidney Transplantation

June 15, 2022 | Webinar

Faswal Pichan

Clinical Dialysis Technologist

Scientific Tracks Abstracts: June 15, 2022 | Webinar

Abstract :

Plant toxins are known to cause Acute Kidney Injury in tropical countries. We report 3 cases of Acute Oxalate Nephropathy following ingestion of Averrhoa bilimbi fruit juice which contribute to nephrotoxicity. Case study Case 1: A 45-year-old female presented to emergency department with B/L pedal edema facial puffiness and abdominal distension of 3-day duration. systemic hypertension and dyslipidemia with poor drug compliance. Diet history reveals consumption of 200 ml of undiluted juice ma de from bunch of lrumban pull 3 days back presuming that it would correct her cholesterol levels. Urine deposits shows plenty of oxalate crystals. Labs are significant for serum creatinine - 7 mg/d1. Kidneys were supported by HD and discharged on day 5 of hospital admission with serum creatinine 1.5 mg/di and adequate urine output. Case 2: A 50- year-old male presented to the emergency department with generalized edema of 3day duration. History of decreased urine output for the past 5days. Not a kick>. DM or HT. Recently diagnosed with dyslipidemia. Diet history reveals consumption of around 100 ml of lrumban pull juice twice daily for 2 days. Lab reveals serum creatinine 6.5 mg/c11. Patient underwent 4 sessions of hemodialysis and was kept on oral prednisolone in view of interstitial nephritis. At the time of discharge patient urine output is adequate with serum creatinine 1.2 mg/di and counselled about the adverse reactions of herbal ingestions Case 3: A 65-year-old female presented to emergency department with c/o breathing difficulty for the past one day associated with B/L pedal edema, facial puffiness and decreased urine output for the past 3 days. Recently diagnosed with dyslipidemia and was not on any medications. History further reveals that she consumed 150 ml of undiluted lrumban puli juice twice 5 days back. Urine deposits shows plenty of oxalate crystals. In all the cases, USG Abdomen shows no renal calculi and no hydro nephrosis and with good renal cortex and medullary differentiation Erumban pull juice concentrate has a significant role in the pathogenesis of AKI with Acute Oxalate Nephropathy. Emergency physicians should be aware of the toxic effects if lrumban puli. Early dialysis will result in good outcome and good prognosis. To create awareness about lrumban Puli among the healthcare professional especially to ED personnel. Emphasis on the public awareness about the dangerous consequences of the plant toxins when consumed as a self-treatment We should be aware about the plant toxins in and around our locality to have high index of suspicion in focused history taking to make quick diagnosis and good management which may result in best outcomes