A Study on the Acute Kidney Injury in Snake Bite Victims in A Tertiary Care Centre

Harshavardhan, L; Lokesh, Araveti; Tejeshwari, H L; Halesha, B R; Metri, Siddharama S

doi:10.7860/jcdr/2013/5495.2957

Cited by 21 publications

(31 citation statements)

References 8 publications

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“…Bite site in majority (85.2%) of patients in current study was lower limb similar (72%-99%) to that in other studies[11,20-24,30]. Education on prevention of snake bite should be imparted among farmers and field workers.…”

Section: Discussionsupporting

confidence: 81%

“…Cellulitis was 39%-98.7%[20,23-26,28-30] as compared to that of 13.6% observed in our study, hypotension of 4.5% observed in current study as compared to that of 6.3%-45.2% in other studies[9,20,23,24,27,29,30], neurotoxicity of 5.7% as compared to that of 3.2%-100% in other studies[11,23,25,28,29]. Bleeding/coagulopathy which is a major symptom of systemic viper poisoning was observed in 88.6% patients as compared to 27.8%-65.8% in other studies of snake bite-induced AKI[11,20,23-26,28-30].…”

Section: Discussioncontrasting

confidence: 46%

“…In various studies, the symptoms of oligoanuria has been reported to be 13.8%-100%[9,11,20,21,23,24,26,28,30] and hematuria/black colored urine 24.6%-80%[9,11,20,22,24,26,29] as compared to that of 79.5% and 54.5% respectively in our study. Cellulitis was 39%-98.7%[20,23-26,28-30] as compared to that of 13.6% observed in our study, hypotension of 4.5% observed in current study as compared to that of 6.3%-45.2% in other studies[9,20,23,24,27,29,30], neurotoxicity of 5.7% as compared to that of 3.2%-100% in other studies[11,23,25,28,29].…”

Section: Discussionsupporting

confidence: 42%

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Clinicopathological spectrum of snake bite-induced acute kidney injury from India

Vikrant¹,

Jaryal²,

Parashar³

2017

WJN

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AIMTo study the clinico-pathological spectrum of snake bite-induced acute kidney injury (AKI).METHODSA retrospective study of patients admitted at Indira Gandhi Medical College Hospital, Shimla with snake bite-induced AKI from July 2003 to June 2016. Medical records were evaluated for patient’s information on demographic, clinical characteristics, complications and outcome. Outcomes of duration of hospital stay, requirement for intensive care unit support, treatment with dialysis, survival and mortality were analyzed. The survival and non survival groups were compared to see the difference in the demographic factors, clinical characteristics, laboratory results, and complications. In patients subjected to kidney biopsy, the findings of histopathological examination of the kidney biopsies were also analyzed.RESULTSOne hundred and twenty-one patients were diagnosed with snake bite-induced AKI. Mean age was 42.2 ± 15.1 years and majority (58%) were women. Clinical details were available in 88 patients. The mean duration of arrival at hospital was 3.4 ± 3.7 d with a range of 1 to 30 d. Eighty percent had oliguria and 55% had history of having passed red or brown colored urine. Coagulation defect was seen in 89% patients. The hematological and biochemical laboratory abnormalities were: Anemia (80.7%), leukocytosis (75%), thrombocytopenia (47.7%), hyperkalemia (25%), severe metabolic acidosis (39.8%), hepatic dysfunction (40.9%), hemolysis (85.2%) and rhabdomyolysis (68.2%). Main complications were: Gastrointestinal bleed (12.5%), seizure/encephalopathy (10.2%), hypertension, pneumonia/acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (9.1% each), hypotension and multi organ failure (MOF) (4.5% each). Eighty-two percent patients required renal replacement therapy. One hundred and ten (90.9%) patient survived and 11 (9.1%) patients died. As compared to the survival group, the white blood cell count (P = 0.023) and bilirubin levels (P = 0.006) were significant higher and albumin levels were significantly lower (0.005) in patients who died. The proportion of patients with pneumonia/ARDS (P = 0.001), seizure/encephalopathy (P = 0.005), MOF (P = 0.05) and need for intensive care unit support (0.001) was significantly higher and duration of hospital stay was significantly shorter (P = 0.012) in patients who died. Kidney biopsy was done in total of 22 patients. Predominant lesion on kidney biopsy was acute tubular necrosis (ATN) in 20 (91%) cases. In 11 cases had severe ATN and in other nine (41%) cases kidney biopsy showed features of ATN associated with mild to moderate acute interstitial nephritis (AIN). One patient only had moderate AIN and one had patchy renal cortical necrosis (RCN).CONCLUSIONAKI due to snake bite is severe and a high proportion requires renal replacement therapy. On renal histology ATN and AIN are common, RCN is rare.

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Section: Discussionsupporting

confidence: 81%

Section: Discussioncontrasting

confidence: 46%

Section: Discussionsupporting

confidence: 42%

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Clinicopathological spectrum of snake bite-induced acute kidney injury from India

Vikrant¹,

Jaryal²,

Parashar³

2017

WJN

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“…The fatality rate was 19.3%, which is also in the reported range (8.0–39.0%) among patients with snakebite envenomation [9–11, 13, 14]. When clinical parameters and management of patients with sAKI were compared between patients who died and those who survived, patients who died were more likely to develop shock, have pulmonary complications, and receive management in the intensive care unit.…”

Section: Discussionmentioning

confidence: 63%

Clinical and laboratory parameters associated with acute kidney injury in patients with snakebite envenomation: a prospective observational study from Myanmar

et al. 2017

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BackgroundSnakebite-related acute kidney injury (AKI) is a common community-acquired AKI in tropical countries leading to death and disability. The aims of this study were to (1) determine the occurrence of snakebite-related AKI, (2) assess factors at presentation that are associated with snakebite-related AKI, and (3) determine the outcomes of patients with snakebite-related AKI.MethodsWe conducted a prospective observational study of patients with snake envenomation at the three academic tertiary care hospitals in Yangon, Myanmar between March 2015 and June 2016. Patient data including baseline characteristics, clinical and laboratory findings, hospital management, and outcomes were recorded in a case report form. A stepwise multivariate logistic regression analysis using a backward selection method determined independent factors significantly associated with AKI.ResultsAKI was observed in 140 patients (54.3%), the majority of whom were AKI stage III (110 patients, 78.6%). AKI occurred at presentation and developed during hospitalization in 88 (62.9%) and 52 patients (37.1%), respectively. Twenty-seven patients died (19.3%), and 69 patients (49.3%) required dialysis. On multivariate logistic regression analysis, (1) snakebites from the Viperidae family (odds ratio [OR]: 9.65, 95% confidence interval [CI]: 2.42–38.44; p = 0.001), (2) WBC >10 × 103 cells/μL (OR: 3.55, 95% CI: 1.35–9.34; p = 0.010), (3) overt disseminated intravascular coagulation (OR: 2.23, 95% CI: 1.02–4.89; p = 0.045), (4) serum creatine kinase >500 IU/L (OR: 4.06, 95% CI: 1.71–9.63; p = 0.001), (5) serum sodium <135 mmol/L (OR: 4.37, 95% CI: 2.04–9.38; p < 0.001), (6) presence of microscopic hematuria (OR: 3.60, 95% CI: 1.45–8.91; p = 0.006), and (7) duration from snakebite to receiving antivenom ≥2 h (OR: 3.73, 95% CI: 1.48–9.37; p = 0.005) were independently associated with AKI. Patients bitten by Viperidae with normal renal function who had serum sodium <135 mmol/L had a significantly higher urine sodium-to-creatinine ratio than those with serum sodium ≥135 mmol/L (p < 0.001).ConclusionsIdentifying factors associated with snakebite-related AKI might help clinicians to be aware of snakebite patients who are at risk of AKI, particularly patients who demonstrate renal tubular dysfunction after Viperidae bites.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0510-0) contains supplementary material, which is available to authorized users.

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“…Coagulation disorders induced by hemostatically active components found in the venom are followed by local and systemic hemorrhage and also by other common secondary effects such as hypotension, circulation microthrombi deposition and organ failure (Teixeira et al 2011;Suntravat et al 2011;Silva et al 2013;Harshavardhan et al 2013;Yamashita et al 2014 …”

Section: Introductionmentioning

confidence: 99%

Moojenactivase, a novel pro-coagulant PIIId metalloprotease isolated from Bothrops moojeni snake venom, activates coagulation factors II and X and induces tissue factor up-regulation in leukocytes

et al. 2015

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Coagulopathies following snakebite are triggered by pro-coagulant venom toxins, in which metalloproteases play a major role in envenomation-induced coagulation disorders by acting on coagulation cascade, platelet function and fibrinolysis. Considering this relevance, here we describe the isolation and biochemical characterization of moojenactivase (MooA), a metalloprotease from Bothrops moojeni snake venom, and investigate its involvement in hemostasis in vitro. MooA is a glycoprotein of 85,746.22 Da, member of the PIIId group of snake venom metalloproteases, composed of three linked disulfide-bonded chains: an N-glycosylated heavy chain, and two light chains. The venom protease induced human plasma clotting in vitro by activating on both blood coagulation factors II (prothrombin) and X, which in turn generated α-thrombin and factor Xa, respectively. Additionally, MooA induced expression of tissue factor (TF) on the membrane surface of peripheral blood mononuclear cells (PBMC), which led these cells to adopt pro-coagulant characteristics. MooA was also shown to be involved with production of the inflammatory mediators TNF-α, IL-8 and MCP-1, suggesting an association between MooA pro-inflammatory stimulation of PBMC and TF up-regulation. We also observed aggregation of washed platelets when in presence of MooA; however, the protease had no effect on fibrinolysis. Our findings show that MooA is a novel hemostatically active metalloprotease, which may lead to the development of coagulopathies during B. moojeni envenomation. Moreover, the metalloprotease may contribute to the development of new diagnostic tools and pharmacological approaches applied to hemostatic disorders.

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A Study on the Acute Kidney Injury in Snake Bite Victims in A Tertiary Care Centre

Cited by 21 publications

References 8 publications

Clinicopathological spectrum of snake bite-induced acute kidney injury from India

Clinicopathological spectrum of snake bite-induced acute kidney injury from India

Clinical and laboratory parameters associated with acute kidney injury in patients with snakebite envenomation: a prospective observational study from Myanmar

Moojenactivase, a novel pro-coagulant PIIId metalloprotease isolated from Bothrops moojeni snake venom, activates coagulation factors II and X and induces tissue factor up-regulation in leukocytes

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