Clinical predictors of acute kidney injury following snake bite envenomation

Dharod, Mrudul; Patil, Tushar; Deshpande, Archana; Gulhane, Ragini V; Patil, Mangesh; Bansod, Y. V.

doi:10.4103/1947-2714.120795

Cited by 32 publications

(26 citation statements)

References 15 publications

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“…In addition, patients bitten by Viperidae who presented with capillary leakage, rhabdomyolysis, and hyponatremia were at increased risk for the development of sAKI during hospitalization. Previous studies reported similar factors associated with the sAKI, including receipt of antivenom >2 h after snakebite, cellulitis, hypotension, and rhabdomyolysis [9, 10, 13]. A previous case series from Taiwan showed that early specific antivenom treatment within 3 to 6 h after snake envenoming could restore coagulation abnormalities in 1 to 2 days and was effective in reducing the severity of renal damage [28].…”

Section: Discussionmentioning

confidence: 84%

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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Section: Discussionmentioning

confidence: 84%

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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“…[ 4 ] They are neurotoxic Elapidae , including common Cobra ( Naja naja ), King Cobra ( Ophiophagus hannah ), and Krait ( Bungarus caeruleus , Bungarus fasciatus ); and vasculotoxic Viperidae , Russell's viper ( Daboia russelii ), and saw-scaled viper ( Echis carinatus ). [ 3 ] Acute renal failure is an important complication of Russell's viper and saw-scaled viper species of snakes in India. [ 7 ] Up to 70% of the protein content of viper venom is phospholipase A 2 , present in the form of at least seven isoenzymes.…”

Section: Discussionmentioning

confidence: 99%

“…Intravascular hemolysis due to phospholipase A2 is a significant factor in the pathogenesis of snake bite-induced AKI. [ 3 ] The most common coagulopathy in snake bite is venom-induced consumption coagulopathy (VICC) which results from activation of the coagulation pathway by snake toxins. [ 16 ] In a proportion of patients with VICC, a clinical syndrome consistent with thrombotic microangiopathy has been reported, and it is characterized by acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia.…”

Section: Discussionmentioning

confidence: 99%

Early demographic and clinical predictors of developing acute kidney injury in snake bite patients: A retrospective controlled study from an Indian tertiary care hospital in North Eastern Uttar Pradesh India

Singh¹,

Uraiya²,

Kumar³

et al. 2016

Indian Journal of Critical Care Medicine

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Aims:This study was conducted retrospectively to define early demographic and clinical predictors for acute kidney injury (AKI) among snake bite patients at the time of hospital admission.Materials and Methods:We analyzed 138 cases with a poisonous snake bite. Patients were classified into two groups according to the presence and absence of AKI. The data regarding clinical features and demographic profile of these patients were collected from the hospital records in a prestructured pro forma and statistically compared.Results:Of the 138 patients of venomous snake bite, 62 developed AKI (44.92%). Patients who developed AKI were older in age. Moreover, prolonged bite to anti-snake venom (ASV) time had a significant relationship in developing AKI (P < 0.05). Among the clinical features, there was an independent positive association of AKI with abdomen pain, tenderness and vomiting, cellulitis, bleeding tendencies, myalgia, and black or brown urine (P < 0.05). Neurological features were inversely associated with renal involvement.Conclusion:We found that marked abdominal pain, tenderness and vomiting, myalgia, black or brown urine, bite site cellulitis, bleeding tendencies, and prolonged (>2 h) bite to ASV time were significantly associated with the development of AKI in snake bite patients.

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“…In India, patient-related factors such as child age, previous health condition and time elapsed until medical assistance can act as risk factors for severity, sequelae and death [ 22 – 26 ]. In the same country, patients admitted with symptoms of neurotoxicity and vomiting [ 22 , 24 ], coagulopathy and leukocytosis [ 23 ], hypertension, albuminuria, changes in bleeding and prothrombin time [ 25 ] were more likely to develop severe outcomes. The delay in antivenom administration was also a risk factor for severity in Nigeria [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Older Age and Time to Medical Assistance Are Associated with Severity and Mortality of Snakebites in the Brazilian Amazon: A Case-Control Study

Sampaio²,

et al. 2015

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The Amazon region reports the highest incidence of snakebite envenomings in Brazil. We aimed to describe the epidemiology of snakebites in the state of Amazonas and to investigate factors associated with disease severity and lethality. We used a nested case-control study, in order to identify factors associated with snakebite severity and mortality using official Brazilian reporting systems, from 2007 to 2012. Patients evolving to severity or death were considered cases and those with non-severe bites were included in the control group. During the study period, 9,191 snakebites were recorded, resulting in an incidence rate of 52.8 cases per 100,000 person/years. Snakebites mostly occurred in males (79.0%) and in rural areas (70.2%). The most affected age group was between 16 and 45 years old (54.6%). Fifty five percent of the snakebites were related to work activities. Age ≤15 years [OR=1.26 (95% CI=1.03-1.52); (p=0.018)], age ≥65 years [OR=1.53 (95% CI=1.09-2.13); (p=0.012)], work related bites [OR=1.39 (95% CI=1.17-1.63); (p<0.001)] and time to medical assistance >6 hours [OR=1.73 (95% CI=1.45-2.07); (p<0.001)] were independently associated with the risk of severity. Age ≥65 years [OR=3.19 (95% CI=1.40-7.25); (p=0.006)] and time to medical assistance >6 hours [OR=2.01 (95% CI=1.15-3.50); (p=0.013)] were independently associated with the risk of death. Snakebites represent an occupational health problem for rural populations in the Brazilian Amazon with a wide distribution. These results highlight the need for public health strategies aiming to reduce occupational injuries. Most cases of severe disease occurred in the extremes of age, in those with delays in medical attention and those caused by Micrurus bites. These features of victims of snakebite demand adequate management according to well-defined protocols, including prompt referral to tertiary centres when necessary, as well as an effective response from surveillance systems and policy makers for these vulnerable groups.

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Clinical predictors of acute kidney injury following snake bite envenomation

Cited by 32 publications

References 15 publications

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

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

Early demographic and clinical predictors of developing acute kidney injury in snake bite patients: A retrospective controlled study from an Indian tertiary care hospital in North Eastern Uttar Pradesh India

Older Age and Time to Medical Assistance Are Associated with Severity and Mortality of Snakebites in the Brazilian Amazon: A Case-Control Study

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