RESUMO
A insuficiência renal crônica é doença de elevada morbidade e mortalidade e sua incidência e prevalência em estágio terminal têm aumentado progressivamente a cada ano. Segundo a Sociedade Brasileira de Nefrologia, as principais causas de insuficiência renal crônica são hipertensão arterial, glomerulonefrite e diabetes mellitus. Diversos fatores elevam o risco de mortalidade em pacientes com nefropatia crônica, principalmente idade, presença de diabetes e número de comorbidades associadas. Para pacientes com menos de 50 anos de idade a taxa de sobrevida em 5 anos é de 62 por cento e para aqueles acima desta idade e com diagnóstico de diabetes mellitus a sobrevida é de apenas 23 por cento. A carambola, fruta originária da Ásia e muito difundida na maioria dos países tropicais, tem sido reportada como contendo uma neurotoxina capaz de provocar graves alterações neurológicas em pacientes com histórico de nefropatia crônica. Dentre estas alterações podemos observar desde quadros leves, como soluços e confusão mental, até quadros mais sérios, como convulsões e morte. Essa neurotoxina parece apresentar especificamente inibição sobre o sistema de condução GABAérgico. Descrevemos o caso de um paciente nefropata crônico que, após ingestão de carambola, inicia quadro de mal-estar, náuseas e vômitos, seguidos de episódios convulsivos reentrantes e vai a óbito mesmo com o tratamento hemodialítico convencional.
Chronic renal failure is a high morbidity and mortality condition, with its terminal phase incidence and prevalence steadily growing year after year. According to the Sociedade Brasileira de Nefrologia [Brazilian Society of Nephrology], the main causes of renal failure are arterial hypertension, glomerulonephritis and diabetes mellitus. Several factors are implied on chronic renal failure patients' risk of mortality, particularly age, diabetes and associated co-morbidities. For patients below 50 years old, the 5 years survival rate is 62 percent and for those above this age and with diabetes mellitus, just 23 percent. Star fruit is native from Asia, and widespread in tropical countries; this fruit was reported as having a neurotoxin able to cause serious neurological changes in chronic renal disease patients. These may range from mild features, such as hiccup and confusion, to serious episodes with seizures and death. This neurotoxin apparently inhibits specifically the GABAergic conduction system. This paper describes a case involving a chronic renal disease patient who, after ingesting star fruit, featured malaise, nausea and vomiting, followed by repeated convulsions and died even though undergoing conventional hemodialysis therapy.
RESUMO
Chronic renal failure is a high morbidity and mortality condition, with its terminal phase incidence and prevalence steadily growing year after year. According to the Sociedade Brasileira de Nefrologia [Brazilian Society of Nephrology], the main causes of renal failure are arterial hypertension, glomerulonephritis and diabetes mellitus. Several factors are implied on chronic renal failure patients' risk of mortality, particularly age, diabetes and associated co-morbidities. For patients below 50 years old, the 5 years survival rate is 62% and for those above this age and with diabetes mellitus, just 23%. Star fruit is native from Asia, and widespread in tropical countries; this fruit was reported as having a neurotoxin able to cause serious neurological changes in chronic renal disease patients. These may range from mild features, such as hiccup and confusion, to serious episodes with seizures and death. This neurotoxin apparently inhibits specifically the GABAergic conduction system. This paper describes a case involving a chronic renal disease patient who, after ingesting star fruit, featured malaise, nausea and vomiting, followed by repeated convulsions and died even though undergoing conventional hemodialysis therapy.
