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

Abstract

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.

Study of clinical profile and outcome of acute kidney injury in acute poisoning and envenomation

“…Cortical necrosis in renal biopsy indicates poor prognosis and it is classically produced by the bite of Russell's viper. Similar findings were done by Vikrant et al 9 Delay in administration of ASV might be the reason for the development of renal lesions. 12 In this study, out of 19 patients with bite, wasp sting bite was seen in one patient and presented with renal failure with MODS.…”

“…hospital was 3.4 days. 9 Kalantri et al noted mean bite to hospital time of 6.5±10.3 hours. 10 In our study out of 17 AKI in snake bites, hypotension occurred in only 3 patients and all three patients expired.…”

Prognosis and long-term outcomes of acute kidney injury due to snake envenomation

“…In this study, we observed that 44% of patients with poisonous snakebites developed AKI. The reported prevalence rates of AKI following haemotoxic envenomation vary from 14 to 44% [ 4–8 , 15 ]. Relatively higher AKI prevalence rates have been reported by studies that have employed both urine output and creatinine-based criteria for the diagnosis of AKI, compared with studies that have employed creatinine-based criteria alone [ 5 , 8 , 16 ].…”

“…Envenomation is a common cause of community-acquired acute kidney injury (AKI) in tropical and subtropical areas, contributing to significant morbidity and mortality [ 2 , 3 ]. Even though AKI is a recognized complication of snakebite, the existing data concerning outcomes of AKI resulting from haemotoxic envenomation have been limited by retrospective study designs, a lack of uniformity in case definitions of AKI and limited follow-up [ 4–8 ]. The recent Kidney Disease: Improving Global Outcomes (KDIGO) definition and staging criteria have facilitated the early diagnosis of AKI, but the prognostic utility of these classification schemas in snakebite-related AKI is not known.…”

Ameliorating effect of Alstonia scholaris L. bark extract on histopathological changes following viper envenomation in animal models

“…Besides lethal effects snake envenomation also induces a wide range of local effects which can not be neutralized by anti serum. Nephropathy induced by snake venom was mentioned by Vikrant et al [ 1 ]. Histo-pathological examination showed intense dose and time dependent abnormalities, including swelling glomerulus and tubular necrosis and damage as well as signs of intertubular medullary hemorrhage at early stages of envenomation in kidney sections [ 2 ]· Viper envenomation is associated with degeneration and necrosis.…”