"Green Smoothie Cleanse" Causing Acute Oxalate Nephropathy

Am J Kidney Dis. 2018 Feb;71(2):281-286. doi: 10.1053/j.ajkd.2017.08.002. Epub 2017 Dec 6.


Oxalate nephropathy is an uncommon condition that causes acute kidney injury with the potential for progression to end-stage renal disease. Diagnosis is based on the kidney biopsy findings of abundant polarizable calcium oxalate crystals in the epithelium and lumen of renal tubules. We report a case of acute oxalate nephropathy in a 65-year-old woman, temporally associated with the consumption of an oxalate-rich green smoothie juice "cleanse" prepared from juicing oxalate-rich green leafy vegetables and fruits. Predisposing factors included a remote history of gastric bypass and recent prolonged antibiotic therapy. She had normal kidney function before using the cleanse and developed acute kidney injury that progressed to end-stage renal disease. Consumption of such juice cleanses increases oxalate absorption, causing hyperoxaluria and acute oxalate nephropathy in patients with predisposing risk factors. Given the increasing popularity of juice cleanses, it is important that both patients and physicians have greater awareness of the potential for acute oxalate nephropathy in susceptible individuals with risk factors such as chronic kidney disease, gastric bypass, and antibiotic use.

Keywords: Oxalate; Roux-en-Y gastric bypass (RYGB); acute kidney injury (AKI); acute oxalate nephropathy (AON); acute renal failure; crystal; diet; juicing; kidney biopsy; moxifloxacin; spinach; weight-loss.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury* / diagnosis
  • Acute Kidney Injury* / etiology
  • Acute Kidney Injury* / physiopathology
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Disease Progression
  • Female
  • Fruit and Vegetable Juices / adverse effects*
  • Gastric Bypass / adverse effects
  • Humans
  • Hyperoxaluria / diagnosis
  • Hyperoxaluria / etiology
  • Kidney / pathology*
  • Kidney Failure, Chronic* / diagnosis
  • Kidney Failure, Chronic* / etiology
  • Kidney Failure, Chronic* / physiopathology
  • Oxalates / adverse effects*
  • Renal Dialysis / methods*
  • Risk Factors
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Oxalates