Case series / case reportindependent cross-checkabstract checked I-VEG-122 standard review
Green smoothie cleanse led to kidney failure
"Green Smoothie Cleanse" Causing Acute Oxalate Nephropathy.
Overview
Makkapati S et al.. Am J Kidney Dis 2018 · PMID 29203127 · DOI 10.1053/j.ajkd.2017.08.002
A 65-year-old woman with earlier gastric bypass developed permanent kidney failure after a green juice cleanse.
Does the study support the specific claim? Yes · Methodological quality: very low
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Report a case.
- How was the study done?
Case report.
- How many people, animals or samples were studied?
1 patient.
- What was actually found?
Oxalate nephropathy to ESRD.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Juice cleanses can be dangerous for people with bowel surgery or kidney disease.
- What are the study's limitations?
Single case.
- What does it say about Elawady's specific claim?
Supports conditional claim.
- Do the results apply to Germany and Europe?
Universal.
- What can explicitly not be concluded from this study?
Cannot generalise to normal vegetable intake.
Scientific in-depth review
1. Full reference
- Authors
- Makkapati S et al.
- Journal
- Am J Kidney Dis
- Year
- 2018
- Identifier
- PMID 29203127 DOI 10.1053/j.ajkd.2017.08.002
- Verification
- verified – PubMed efetch 2026-10-26; Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract
2. Research question
Can a green-smoothie juice cleanse cause acute oxalate nephropathy?
3. Study design and population
- Study design
- Case series / case report – Case report
- Population
65-year-old woman with remote gastric bypass and recent antibiotics
- Country
USA
- Period
not stated
- Sample size
1
- Inclusion and exclusion criteria
not stated in abstract
4. Methods and endpoints
- Exposure / intervention
Oxalate-rich green smoothie juice cleanse (leafy vegetables and fruits)
- Comparator
none
- Endpoints
Kidney function, biopsy
- Statistical methods
none
5. Actual results
- Results
Normal baseline kidney function; acute oxalate nephropathy temporally associated with the cleanse, progressing to end-stage renal disease; predisposing factors: gastric bypass, prolonged antibiotics.
- Absolute risks
not reported
- Authors' conclusion
Juice cleanses increase oxalate absorption and can cause acute oxalate nephropathy in susceptible people (CKD, gastric bypass, antibiotic use).
6. Strengths
- Biopsy-proven
7. Weaknesses
- Single case; multiple predisposing factors
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- high
- Rationale
Case report.
9. Assessment of the statistical interpretation
not applicable
10. Relevance to the specific claim
Illustrates the mechanism in a susceptible person.
11. Independent contrary findings
none
12. Transferability to Germany and Europe
Universal.
13. Overall methodological judgement
Consistent with other cases; cannot quantify risk.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | very low |
| Risk of bias | high |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
none