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

Singh, Rupa; Uraiya, Dharmendra; Kumar, Anoop; Tripathi, Neeraj

doi:10.4103/0972-5229.186221

Cited by 8 publications

(9 citation statements)

References 15 publications

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“…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%

“…They have mainly come from Asia[ 9 , 6 - 30 ] and South America[ 11 , 25 ]. These studies both retrospective[ 9 , 21 , 22 , 25 , 27 - 29 ] and prospective[ 11 , 20 , 23 , 24 , 26 , 30 ] have been carried over a period of 1-25 years. All except one[ 26 ] have been in adult patients.…”

Section: Discussionmentioning

confidence: 99%

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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: 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 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 ].…”

Section: Discussionmentioning

confidence: 99%

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

Priyamvada

Jaswanth

Bobby

et al. 2019

Clinical Kidney Journal

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Background Snakebite is a common occupational hazard in tropical countries. To date, the literature on snakebite-related acute kidney injury (AKI) has been limited by retrospective study designs, lack of uniformity in case definitions of AKI and limited follow-up. This study aims to identify the in-hospital outcomes and long-term changes in kidney function that follow haemotoxic envenomation. Methods All adult patients admitted with AKI following haemotoxic envenomation from January 2016 to June 2017 were recruited and followed up until July 2018. Predictors of in-hospital mortality was assessed. Long-term follow-up data on kidney function were collected from survivors. Results In total, 184 patients with haemotoxic envenomation and AKI were recruited. The mean age of the subjects was 42.2 years [95% confidence interval (CI) 40.3–44.7]. The majority were male (71.2%). The mortality of patients with haemotoxic envenomation was 21.5%. The mortality was considerably higher in patients with Kidney Disease: Improving Global Outcomes (KDIGO) Stage 3 AKI [relative risk (RR) 4.45 (95% CI 1.14–17.42)] and those who met KDIGO urine output criteria [RR 20.45 (95% CI 2.84–147.23)]. A Cox regression model identified mechanical ventilation [odds ratio (OR) 5.59 (95% CI 2.90–10.81)], hypotension [OR 2.48 (95% CI 1.31–4.72)] and capillary leak syndrome [OR 2.02 (95% CI 1.05–3.88)] as independent predictors of mortality. Long-term follow-up data were available for 73 patients. A total of 21 patients (28.7%) developed adverse renal outcomes (glomerular filtration rate <60 mL/min/1.73 m2, urine albumin excretion >30 mg/g and new-onset hypertension or prehypertension). Conclusions AKI resulting from snake envenomation is associated with considerable risk of mortality. The greater the AKI stage the greater the likelihood of mortality. One-third of patients with AKI developed long-term complications like chronic kidney disease, prehypertension and hypertension over the follow-up period.

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“…This was the consequence of antivenom inaccessibility, the cost of which (42,000 FCFA or US $ 70 per vial) representing several months of income for a Beninese farmer. The critical threshold of treatment delay was estimated by many authors below 2 hours after snakebite [ 20 , 48 , 49 , 53 ]. However, Alves et al [ 54 ] reported that 58% of the AKIs in their series were admitted to hospital less than 3 hours after the bite -meaning that early treatment was unable to prevent AKI-, and Ratnayake et al [ 45 ] did not show any difference according to treatment time between patients without AKI and those with AKI whatever the severity.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney failure following severe viper envenomation: clinical, biological and ultrasonographic aspects

Tchaou¹,

Tové²,

N'Vènonfon³

et al. 2020

J. Venom. Anim. Toxins incl. Trop. Dis

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Background: Acute kidney injury (AKI) is a frequent complication of snakebite envenomation, which is still little known in sub-Saharan Africa. This study aims to describe the clinical, biological and ultrasonographic aspects of AKI following severe snakebite envenomation managed in the intensive care unit. Method: A prospective observational survey was performed in Benin over a period of 18 months. All patients suffering severe snakebite envenomation (SBE) were included. The diagnosis of AKI was made using the KDIGO criteria. Kidney ultrasound exam was performed in all patients to assess internal bleeding and morphological and structural abnormalities of the kidneys. R esults: Fifty-one cases of severe SBE were included. All patients presented inflammatory syndrome and showed abnormal WBCT whereas bleeding was found in 46 of them (90%). The median time to hospital presentation was three days. The majority of patients were male (M/F sex ratio = 1.55) and the median age was 26. Sixteen patients (31%) showed AKI according to the KDIGO criteria. Severe AKI (KDIGO stage 2 and 3) was observed in three patients, including one stage 2 and two stage 3. Kidney ultrasound revealed three cases of kidney capsular hematoma (6%), two cases of kidney hypertrophy (3%), three cases of kidney injury (4%), two stage 1 KDIGO and one stage 2 KDIGO. Only one patient benefited from hemodialysis. All patients showing AKI recovered without sequels. The median duration of hospital stays was four days. Seven patients died (14%) including four among the 16 AKI patients. Antivenom has been administered to 41 patients (80%). The comparison between patients without and with AKI did not show any significant difference except gender (p = 10 -2 ). C onclusion: AKI is a common complication of severe snakebite envenomation. Resulting from inflammatory and hemorrhagic disorders, AKI may prove to be a short-term life-threatening factor.

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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

Cited by 8 publications

References 15 publications

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

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

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

Acute kidney failure following severe viper envenomation: clinical, biological and ultrasonographic aspects

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