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Star fruit

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Clinical Nephrotoxins

The carambola or star fruit belongs to the Oxalidaceae family, species Averrhoa carambola. Slices cut in cross-section have the form of a star (Figure 1). It is believed to have originated in Ceylon and the Moluccas but it has been cultivated in southeast Asia and Malaysia for many centuries. It is commonly grown in some provinces in southern China, in Taiwan and India. It is rather popular in the Philippines and Queensland, Australia and moderately so in some of the South Pacific Islands, particularly Tahiti, New Caledonia and Netherlands New Guinea, and in Guam and Hawaii. There are some subspecies in the Caribbean Islands, in Central America and in tropical West Africa. It is also common in Brazil, where it is served as fresh beverage, in natura, or as an industrialized juice, as it is also served throughout the world. It was introduced into Southern Florida before 1887 and the fruits are also available in many European countries and Canada. It is widely used in restaurants for decorative purposes. In India, ripe fruit is administered to halt hemorrhages and to relieve bleeding hemorrhoids. In Brazil, star fruit is recommended as a diuretic for kidney and bladder complaints [1, 2].

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References

  1. Morton JF. Fruits of warm climates. Flair Books, Miami, FL, 1987:pp125-128.

    Google Scholar 

  2. Margen S. The Wellness Encyclopedia of Food and Nutrition. Health Letter Assoc. New York, NY; 1992:pp271-272.

    Google Scholar 

  3. Martin LC, Caramori JST, Barretti P, Soares VA. Soluço intratável desencadeado por ingestão de carambola (averrhoa carambola)em portadores de insuficiência renal crônica. J Bras Nefrol 1993; 15:92-94.

    Google Scholar 

  4. Neto MM, Robl F, Netto JC. Intoxication by star fruit (averrhoa carambola) in six dialysis patients? ( Preliminary report). Nephrol Dial Transpl 1998;13:570-572.

    Article  Google Scholar 

  5. Chang JM, Hwang SJ, Kuo HT, Tsai JC, Guh JY, Chen HC, Tsai JH, Lai YH. Fatal outcome after ingestion of star fruit (averrhoa carambola) in uremic patients.Am J Kidney Dis 2000; 35:189-193.

    Article  PubMed  Google Scholar 

  6. Wang JL, Cheng CH, Wu MJ, Chen CH, D, Shu KH. (In Chinese) Status epilepticus in two patients with chronic renal failure after ingestion of star fruit. Kidney Dialysis 2000; 8:166-169.

    Google Scholar 

  7. Lo KL, Tong GMW, Wong PN, Mak SK, Wong AKM. Persistent hiccup in a continuous ambulatory peritoneal dialysis patient following ingestion of star fruit. Hong Kong Journal of Nephrology 2001; 3(1):45-46.

    Article  Google Scholar 

  8. Ho MP, Pai MF, Fan CD, Chang KS. Neurological Manifestations Induced by Star fruit (Averrhoa carambola) Intoxication in Patients with Chronic Renal Failure: Two Cases Report. J Taiwan Emerg Med 2001; 3:2-7

    Google Scholar 

  9. Wu CW, Denq JC, Tsai WS, Lin SH. Star fruit-induced neurotoxicity in two patients with chronic renal failure. J Med Sci 2002;22(2).

    Google Scholar 

  10. Yap HJ, Chen YC, Fang JT, Huang CC. Star fruit: a neglected bu serious fruit intoxicant in chronic renal failure. Dialysis & Transplantation. 2002; 31:564.

    Google Scholar 

  11. Chan YL, Leung CB, Yeung DKW. Phosporus and single voxel proton MR spectroscopy and diffusion-weighted imaging in a case of star fruit poisoning. Am J Neuroradiol 2002; 23: 1557-1560.

    PubMed  Google Scholar 

  12. Tse KC, Yip PS, Lam MF, Choy BY, Li FK, Lui SL, Lo WK, Chan TM. Star fruit intoxication in uraemic patients: case series and review of the literature. Internal Medicine Journal 2003; 33:314-316.

    Article  PubMed  Google Scholar 

  13. Neto MM, Costa JAC, Garcia-Cairasco N, Netto JC, Nakagawa B, Dantas M. Intoxication by star fruit (averrhoa carambola) in 32 uraemic patients: treatment and outcome. Nephrol Dial Transpl 2003; 18: 120-125.

    Article  Google Scholar 

  14. Moyses Neto M, Nardim MEP, Vieira-Neto OM, Vannuchi MTI, Raspanti EO. Intoxicação por carambola (averrhoa carambola) em quatro pacientes renais crônicos pré-dialíticos e revisão da literatura. J Bras Nefrol 2003; 26:228-232

    Google Scholar 

  15. Hung SW, Lin ACM, Chong CF, Wang TL, Ma HP. Fatal outcome after Star fruit (Averrhoa carambola) ingestion in patients with chronic renal insufficiency. Ann Disaster Med 2004; 3:56-59.

    Google Scholar 

  16. Chang CH, Yeh JH. Non-convulsive status epilepticus and consciousness disturbance after star fruit (Averrhoa carambola) ingestion in a dialysis patient. Nephrology 2004; 9:362-365

    Article  PubMed  Google Scholar 

  17. Tsai MH, Chang WN, Lui CC, Chung KJ, Hsu KT, Huang CR, Lu CH, Chuang YC. Status epilepticus induced by star fruit intoxication in patients with chronic renal disease. Seizure 2005; 14:521-525

    Article  PubMed  Google Scholar 

  18. Chen LL, Fang JT, Lin JL. Chronic renal disease patients with severe star fruit poisoning: hemoperfusion may be an effective alternative therapy. 2005; 43:181-183

    Google Scholar 

  19. Wu MY, Wu IW, WuSS, Lin JL. Hemoperfusion as an effective alternative therapy for star fruit intoxication: a report of 2 cases. Am J Kidney Dis 2007; 49:E1-E5

    Article  PubMed  Google Scholar 

  20. Wang YCL, Liu BM, Supernaw RB, Lu YH, Lee PY. Management of star fruit-induced neurotoxicity and seizures in a patient with chronic renal failure. Pharmacotherapy 2006; 26:143-146

    Article  PubMed  Google Scholar 

  21. Chien CL, Fang HC, Chou KJ, Wang JS, Chung HM. Acute oxalate nephropathy after ingestion of star fruit. Am J Kidney Dis 2001;37:418-422

    Article  Google Scholar 

  22. Hruska KA, Seltzer JR, Grieff M: Nephrolithiasis, in Schrier RW, Gottschalk CW(eds): Diseases of the Kidney(ed 6). New York, Little Brown, 1977, pp 739-764.

    Google Scholar 

  23. Sanz P. Reig R: Clinical and pathological findings in fatal plant oxalosis: A review. Am J Forensic Med Pathol, 1992; 13: 342-345

    Article  PubMed  Google Scholar 

  24. Fang HC, Chen CL, Wang JS, Chou KJ, Chiou YS, Lee PT, Yeh JH, Yeh MY, Chung HM. Acute oxalate nephropathy induced by star fruit in rats. Am J Kidney Dis 2001; 38:876-880.

    Article  PubMed  Google Scholar 

  25. Fang HC, Lee Po-Tsang, Lu PJ, Chen CL, Chang TY, Hsu CY, Chung HM, Chou KJ. Mechanisms of star fruit-induced acute renal failure. Food Chem Toxicol 2008; 46:1744-1752.

    PubMed  Google Scholar 

  26. Niticharoenpong K, Chalermsanyakorn P, Panvichian R, Kitiyara C. Acute deterioration of renal function induced by star fruit ingestion in a patient with chronic kidney disease. J Nephrol 2006; 19:682-686

    PubMed  Google Scholar 

  27. Muir, CK, Lam, CK. Depressant action of Averrhoa carambola. Med J Malaysia. 1980; XXXIV: 279-80.

    Google Scholar 

  28. Chen CL, Chou KJ, Wang JS, Yeh JH, Fang HC, Chung HM. Neurotoxic effects of carambola in rats: the role of oxalate. J Formos Med Assoc. 2002; 101(5): 337-41.

    PubMed  Google Scholar 

  29. Watt JM, Breyer-Brandwijk MG. The medicinal and poisonous plants of Southern and Eastern Africa. 2nd edition, Edinburgh, Livingstone, 1962.

    Google Scholar 

  30. Fang HC, Chen CL, Lee PT, Hsu CY, Tseng CJ, Lu PJ, Lai SL, Chung HM, Chou KJ. The role oif oxalate in star fruit neurotoxicity of Five-sixths nephrectomized rats. Food Chem Toxicol 2007; 45:1746-1749.

    Google Scholar 

  31. Wilson CW, Shaw PE, Knight-Jr RJ. Analysis of oxalic acid in carambola (Averrhoa carambola L.) and spinach by High-performance liquid chromatography. J. Agric Food Chem 1982; 30(6): 1106-8.

    Article  Google Scholar 

  32. Oliveira RB, Godoy SAP, Costa, FB. Plantas tóxicas: conhecimento e prevenção de acidentes. Ribeirão Preto, Holos, 1. ed., 2003. p64

    Google Scholar 

  33. Wilson CW Shaw PE, Kinght RJ, Nagy S, Klim M. Volatile constituents of carambola (Averrhoa carambola L.). J. Agric. Food Chem.1985; 33:199-201.

    Article  Google Scholar 

  34. Artain N, Maárifa Y, Hanafi M. Isolation and identification of active antioxidant compound from star fruit (Averrhoa carambola) mistletoe (Dendrophthoe pentandra (L.) Miq.) ethanol extract J Appl Science 2006; 8: 1659-1663.

    Google Scholar 

  35. Shui G, Leong, Lai P. Residue from star fruit as valuable source for functional food ingredients and antioxidant nutraceutical. Food Chemistry 2006; 97: 277-284

    Article  Google Scholar 

  36. Gross JIR., Eckhardt G. Carotenoids of the fruit of Averrhoa carambola, Phytochemistry 1983; 22: 1479-1481

    Article  Google Scholar 

  37. Gunasegaran R. Flavonoids and anthocyanins of three oxalidaceae, Fitoterapia, 1992, 63: 89-90.

    Google Scholar 

  38. Jabbar A, Taleb M, Rashid MA, Hasan CM. 5-Hydroxymethyl-2-furfural from Averrhoa carambola Fitoterapia 1995; 66: 377

    Google Scholar 

  39. Shui G, Leong LP. Analysis of polyphenolic antioxidants in star fruit using liquid chromatography and mass spectrometry. J Chromatogr A 2004; 1022: 67-75

    Article  PubMed  Google Scholar 

  40. Guaratini T, Vessecchi RL, Lavarda FC, Maia Campos PM, Naal Z, Gates PJ, Lopes NP. New chemical evidence for the ability to generate radical molecular ions of polyenes from ESI and HR-MALDI mass spectrometry. Analyst 2004;129: 1223-1226

    Article  PubMed  Google Scholar 

  41. Guaratini T, Vessecchi R, Pinto E, Colepicolo P, Lopes NP. Balance of xanthophylls molecular and protonated molecular ions in electrospray ionization. J Mass Spectrom 2005; 40: 963-968.

    Article  PubMed  Google Scholar 

  42. Guaratini T, Gates PJ, Cardozo KH, Campos PM, Colepicolo P, Lopes NP. Letter: Radical ion and protonated molecule formation with retinal in electrospray and nanospray. Eur J Mass Spectrom 2006; 12:71-74.

    Article  Google Scholar 

  43. Guaratini T, Lopes NP, Pinto E, Colepicolo P, Gates PJ. Mechanism for the elimination of aromatic molecules from polyenes in tandem mass spectrometry. Chem Commun 2006;39: 4110-4112.

    Article  Google Scholar 

  44. Carolino RO, Beleboni RO, Pizzo AB, Vecchio FD, Garcia-Cairasco N, Moyses-Neto M, Santos WF, Coutinho-Netto J. Convulsant activity and neurochemical alterations induced by a fraction obtained from fruit Averrhoa carambola (Oxalidaceae: Geraniales). Neurochem Int. 2005; 46: 523-31.

    Article  PubMed  Google Scholar 

  45. Bradford HF. Glutamate, GABA and epilepsy. Prog Neurobiology 1995; 47:477-511.

    Article  Google Scholar 

  46. Engelborghs S, D’Hooge R, De Deyn PP. Pathophysiology of epilepsy. Acta Neurol Belgica 2000; 100: 201-13.

    Google Scholar 

  47. Gray EG, Whittaker VP. The isolation of nerve ending brain: and electron-microscopic study of cell fragments derived by homogenization and centrifugation. J Anat 1962; 96:79-87

    PubMed  Google Scholar 

  48. Coimbra TM, Cielisnki DA, Humes HD. Epidermal growth factor accelerates renal repair in mercuric chloride nephrotoxicity. Am.J.Physiol 1990; 259: F438-F443.

    PubMed  Google Scholar 

  49. Paxinos, G., Watson, C.H., 1998. The rat brain in stereotaxic coordinates, Academic Press, New York, 256p.

    Google Scholar 

  50. Moraes MF, Galvis-Alonso OY, Garcia-Cairasco N. Audiogenic kindling in the Wistar rat: a potential model for recruitment of limbic structures. Epilepsy Research 2000; 39:251-259.

    Article  Google Scholar 

  51. Garcia-Cairasco N, Del Vecchio F, Oliveira JAC, Dantas M, Moyses-Neto M. A video-EEG study of the neurotoxic effects of star fruit (Averrhoa carambola) juice ingestion in animals with acute renal failure. Proceedings of the 39th European Renal Association and the European Dialysis and Transplantation Meetings, Copenhagen, Denmark. Nephrol Dial Transpl 2000; 17: 89

    Google Scholar 

  52. Leite JP, Garcia-Cairasco N, Cavalheiro EA. New insights from the use of pilocarpine and kainate models. Epilepsy Research 2002; 50: 93-103

    Article  PubMed  Google Scholar 

  53. Tiffany-Castiglioni E, Ehrich M, Dees L, Costa LG, Kodavanti PRS, Lasley SM, Oortgiesen M, Durham HD. Bridging the gap between in vitro and in vivo models for neurotoxicology. Toxicol Sci 1999; 51:178-183.

    Article  PubMed  Google Scholar 

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Neto, M.M., Carolino, R.O., Lopes, N.P., Garcia-Cairasco, N. (2008). Star fruit. In: De Broe, M.E., Porter, G.A., Bennett, W.M., Deray, G. (eds) Clinical Nephrotoxins. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-84843-3_43

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  • DOI: https://doi.org/10.1007/978-0-387-84843-3_43

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