Letter to the Editor
The star fruit as a cause of acute kidney injury
La fruta estrella causa fracaso renal agudo
María Molina
, Enrique Morales, Beatriz Navarro, Candela Moliz, Manuel Praga
Corresponding author
Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
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This fruit is commonly consumed in Asia and Latin America, although with globalisation it is easy to find it in any country across the world. Numerous therapeutic properties have been attributed to it, however carambola is rich in oxalic.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> In patients with chronic kidney disease, the consumption of star fruit is associated to neurological symptoms that can range from hiccups and confusion to coma and death.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,4</span></a> Despite their widespread consumption, there are only about ten cases reported of acute kidney injury (AKI) secondary to carambola consumption.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2,5–8</span></a> Here we present a new case of AKI caused by carambola consumption.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The patient is 55-year-old female from Peru with a personal medical history of smoking, hypertension treated with dietary measures, type II diabetes mellitus controlled with 2 oral antidiabetics, and dyslipidaemia treated with a statin. She went to the emergency room because of low back pain on both sides, with nausea, abdominal pain and asthenia. The physical examination showed blood pressure of 140/80<span class="elsevierStyleHsp" style=""></span>mmHg, mild mucocutaneous dehydration, and pain on palpation of both kidneys areas, with no pain reaction to percussion in both sides. Laboratory test results were: haemoglobin 13.6<span class="elsevierStyleHsp" style=""></span>g/dl, WBC 8300/μl, serum creatinine 4.55<span class="elsevierStyleHsp" style=""></span>mg/dl, urea 113<span class="elsevierStyleHsp" style=""></span>mg/dl, sodium 143<span class="elsevierStyleHsp" style=""></span>mEq/l, potassium 5.1<span class="elsevierStyleHsp" style=""></span>mEq/l, pH 7.30, pCO<span class="elsevierStyleInf">2</span> 37<span class="elsevierStyleHsp" style=""></span>mmHg and HCO<span class="elsevierStyleInf">3</span> 18<span class="elsevierStyleHsp" style=""></span>mmol/l. In urine the results were: sodium 36<span class="elsevierStyleHsp" style=""></span>mEq/l, potassium 31<span class="elsevierStyleHsp" style=""></span>mEq/l, creatinine 101<span class="elsevierStyleHsp" style=""></span>mg/dl and proteinuria 20<span class="elsevierStyleHsp" style=""></span>mg/dl. The urine sediment presented limited bacteriuria, crystals of amorphous urates, 5 WBC and 2 RBC per field. The patient was admitted to the internal medicine service, with an initial diagnosis of possible acute pyelonephritis. However, despite empiric antibiotic therapy with ceftriaxone and intensive serum therapy, renal function did not improve, and so consultation to the nephrology department was requested. Many studies were performed during admission (autoimmunity, viral serology, proteinogram and thyroid profile), with no abnormalities. The ultrasound showed enlarged kidneys (14.8<span class="elsevierStyleHsp" style=""></span>cm on the right and 14<span class="elsevierStyleHsp" style=""></span>cm on the left), with no other findings.</p><p id="par0015" class="elsevierStylePara elsevierViewall">On a second interrogation, the patient admitted to have felt confusion, awkwardness, dizziness, low back pain, abdominal pain and nausea 2<span class="elsevierStyleHsp" style=""></span>h after a large intake of 2–3 glasses of “carambola” juice, while the patient was fasting. Reviewing the literature, the renal and neurological clinical symptoms were consistent with a large intake of this fruit. Treatment with urine alkalinisation was intensified and combined with intakes of magnesium and potassium citrate. After these measures, the patient had polyuria without the need for haemodialysis, and renal function gradually improved to a serum creatinine level of 1.4<span class="elsevierStyleHsp" style=""></span>mg/dl after 3 weeks. Due to the clinical history and the progressive recovery of renal function, no kidney biopsy was performed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Star fruit (<span class="elsevierStyleItalic">Averrhoa carambola</span>) is regularly consumed in Latin America and Asia. It is often consumed in tropical countries, where numerous cases of neuronal toxicity in patients with chronic kidney disease have been reported.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,4</span></a> In 2001, the first 2 cases of AKI due to carambola consumption were published,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and, since then, a total of 10 cases have been reported (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2,5–8</span></a> In addition, there are other fruits in the <span class="elsevierStyleItalic">Averrhoa</span> genus, such as <span class="elsevierStyleItalic">Averrhoa bilimbi</span>, that can cause AKI due to oxalic deposits.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The mechanism by which oxalic acid causes AKI is twofold: first, it is obstructive due to calcium oxalate lithiasis, and second, because oxalate causes apoptosis of tubular epithelial cells.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> The treatments used are non-specific: low doses of steroids, hydration and haemodialysis, after which all patients normalised the renal function. In summary, carambola consumption should be investigated in all patients with unexplained AKI or the presence of oxalic acid deposits in the kidney biopsy.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Molina M, Morales E, Navarro B, Moliz C, Praga M. La fruta estrella causa fracaso renal agudo. Nefrologia. 2017;37:221–222.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 480 "Ancho" => 991 "Tamanyo" => 64032 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image of <span class="elsevierStyleItalic">Averrhoa carambola</span>.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cr.: serum creatinine; GI: gastrointestinal history; HD: haemodialysis; ND: no data; IgAN: IgA nephropathy; NRL: neurological history.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Gender \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">NRL \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline Cr. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Maximum Cr. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Proteinuria \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Urinary sediment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Biopsy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">HD (number) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Final Cr. (days) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Chen et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Haematuria, leukocyturia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (oxalate nephropathy) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.5<span class="elsevierStyleHsp" style=""></span>mg/dl (28) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.7<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Haematuria, leukocyturia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (oxalate nephropathy<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>IgAN) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.5<span class="elsevierStyleHsp" style=""></span>mg/dl (28) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Neto et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79.5<span class="elsevierStyleHsp" style=""></span>μmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anodyne \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97.2<span class="elsevierStyleHsp" style=""></span>μmol/l (ND) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">88.4<span class="elsevierStyleHsp" style=""></span>μmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">548<span class="elsevierStyleHsp" style=""></span>μmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Haematuria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97.2<span class="elsevierStyleHsp" style=""></span>μmol/l (ND) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">106.2<span class="elsevierStyleHsp" style=""></span>μmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">530<span class="elsevierStyleHsp" style=""></span>μmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Leukocyturia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">106.2<span class="elsevierStyleHsp" style=""></span>μmol/l (ND) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">88.4<span class="elsevierStyleHsp" style=""></span>μmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">495<span class="elsevierStyleHsp" style=""></span>μmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Leukocyturia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (oxalate nephropathy) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">88.4<span class="elsevierStyleHsp" style=""></span>μmol/l (ND) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97.2<span class="elsevierStyleHsp" style=""></span>μmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">353<span class="elsevierStyleHsp" style=""></span>μmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Leukocyturia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (oxalate nephropathy) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97.2<span class="elsevierStyleHsp" style=""></span>μmol/l (ND) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Su et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16.4<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Haematuria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (oxalate nephropathy) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.92<span class="elsevierStyleHsp" style=""></span>mg/dl (28) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Scaranello et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.8<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.3<span class="elsevierStyleHsp" style=""></span>mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Haematuria, leukocyturia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.1<span class="elsevierStyleHsp" style=""></span>mg/dl (10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Abeysekera et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80<span class="elsevierStyleHsp" style=""></span>μmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">290<span class="elsevierStyleHsp" style=""></span>μmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Haematuria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (oxalate nephropathy) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85<span class="elsevierStyleHsp" style=""></span>μmol/l (21) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1423363.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Review of published cases of AKI due to carambola consumption.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute oxalate nephropathy after ingestion of star fruit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 23 | 12 | 35 |
| 2024 October | 232 | 49 | 281 |
| 2024 September | 250 | 39 | 289 |
| 2024 August | 262 | 81 | 343 |
| 2024 July | 254 | 57 | 311 |
| 2024 June | 234 | 41 | 275 |
| 2024 May | 384 | 40 | 424 |
| 2024 April | 305 | 44 | 349 |
| 2024 March | 180 | 22 | 202 |
| 2024 February | 161 | 36 | 197 |
| 2024 January | 189 | 31 | 220 |
| 2023 December | 157 | 40 | 197 |
| 2023 November | 154 | 30 | 184 |
| 2023 October | 231 | 33 | 264 |
| 2023 September | 253 | 29 | 282 |
| 2023 August | 214 | 35 | 249 |
| 2023 July | 218 | 31 | 249 |
| 2023 June | 240 | 30 | 270 |
| 2023 May | 194 | 45 | 239 |
| 2023 April | 173 | 28 | 201 |
| 2023 March | 146 | 38 | 184 |
| 2023 February | 152 | 27 | 179 |
| 2023 January | 167 | 33 | 200 |
| 2022 December | 214 | 35 | 249 |
| 2022 November | 235 | 56 | 291 |
| 2022 October | 330 | 40 | 370 |
| 2022 September | 251 | 44 | 295 |
| 2022 August | 252 | 49 | 301 |
| 2022 July | 323 | 55 | 378 |
| 2022 June | 199 | 40 | 239 |
| 2022 May | 148 | 40 | 188 |
| 2022 April | 106 | 43 | 149 |
| 2022 March | 218 | 59 | 277 |
| 2022 February | 163 | 45 | 208 |
| 2022 January | 218 | 51 | 269 |
| 2021 December | 194 | 61 | 255 |
| 2021 November | 156 | 39 | 195 |
| 2021 October | 335 | 55 | 390 |
| 2021 September | 200 | 35 | 235 |
| 2021 August | 196 | 42 | 238 |
| 2021 July | 205 | 36 | 241 |
| 2021 June | 254 | 40 | 294 |
| 2021 May | 164 | 59 | 223 |
| 2021 April | 325 | 233 | 558 |
| 2021 March | 269 | 61 | 330 |
| 2021 February | 229 | 51 | 280 |
| 2021 January | 140 | 60 | 200 |
| 2020 December | 127 | 33 | 160 |
| 2020 November | 140 | 21 | 161 |
| 2020 October | 117 | 24 | 141 |
| 2020 September | 162 | 20 | 182 |
| 2020 August | 140 | 24 | 164 |
| 2020 July | 151 | 28 | 179 |
| 2020 June | 106 | 22 | 128 |
| 2020 May | 138 | 17 | 155 |
| 2020 April | 174 | 19 | 193 |
| 2020 March | 126 | 21 | 147 |
| 2020 February | 215 | 35 | 250 |
| 2020 January | 156 | 21 | 177 |
| 2019 December | 159 | 28 | 187 |
| 2019 November | 134 | 21 | 155 |
| 2019 October | 119 | 18 | 137 |
| 2019 September | 129 | 16 | 145 |
| 2019 August | 75 | 23 | 98 |
| 2019 July | 98 | 20 | 118 |
| 2019 June | 81 | 26 | 107 |
| 2019 May | 68 | 34 | 102 |
| 2019 April | 140 | 51 | 191 |
| 2019 March | 87 | 32 | 119 |
| 2019 February | 63 | 17 | 80 |
| 2019 January | 83 | 24 | 107 |
| 2018 December | 213 | 35 | 248 |
| 2018 November | 278 | 27 | 305 |
| 2018 October | 277 | 22 | 299 |
| 2018 September | 175 | 21 | 196 |
| 2018 August | 130 | 17 | 147 |
| 2018 July | 102 | 16 | 118 |
| 2018 June | 85 | 21 | 106 |
| 2018 May | 140 | 9 | 149 |
| 2018 April | 141 | 7 | 148 |
| 2018 March | 144 | 12 | 156 |
| 2018 February | 139 | 9 | 148 |
| 2018 January | 93 | 8 | 101 |
| 2017 December | 105 | 8 | 113 |
| 2017 November | 81 | 17 | 98 |
| 2017 October | 53 | 11 | 64 |
| 2017 September | 61 | 18 | 79 |
| 2017 August | 88 | 22 | 110 |
| 2017 July | 83 | 12 | 95 |
| 2017 June | 77 | 15 | 92 |
| 2017 May | 65 | 19 | 84 |
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