An Unusual Cause of Oxalate Nephropathy: Acute Kidney Injury After Ingestion of Dried Bilimbi Fruit.

This case report describes a 56-year-old patient who developed acute kidney injury (AKI) requiring temporary dialysis following oral ingestion of dried Averrhoa bilimbi (or bilimbi fruit). The pathophysiology is attributed to the high oxalate content of the fruit, which can precipitate as calcium oxalate crystals within the renal tubules and lead to tubular obstruction, inflammation, and acute tubular injury. While previous cases have reported AKI after the consumption of fresh bilimbi fruit or its juice, this is, to our knowledge, the first documented case following the ingestion of dried bilimbi fruit. We describe the pathophysiology of secondary hyperoxaluria and its diagnostic evaluation, focusing on a thorough review of medications, comorbidities, detailed dietary history, and nutritional habits. Although the presence of oxalate crystals in a urine sample can help in the diagnostic workup, their absence does not exclude oxalate nephropathy, and renal biopsy remains the gold standard for confirmation. Treatment is supportive, focusing on the cessation of oxalate intake, adequate hydration, and, if necessary, temporary renal replacement therapy. The sooner the above-mentioned measures are taken, the more favorable the prognosis. However, chronic kidney disease (CKD) may persist. This case report highlights the need for heightened clinical suspicion and comprehensive dietary and medical assessment in patients presenting with unexplained AKI.