Incidence & prognosis of acute kidney injury in individuals of snakebite in a tertiary care hospital in India

Abstract

Background & objectives:The snakebites are considered to be an occupational hazard in agriculture workers and the snake handlers, resulting in a considerable morbidity, mortality and economical implications. This study was conducted to determine the incidence, clinical presentation, renal injury and clinical outcome in snakebite victims who developed acute kidney injury (AKI).Methods:This hospital-based prospective, observational study was done on 100 cases who were admitted for the management of snakebite and found to develop AKI in a tertiary care hospital at Hyderabad, India. Renal function tests, complete blood picture, urine routine examination, ultrasound examination of abdomen and coagulation profile were done and the prognosis was assessed by noting recovery, mortality, morbidity and/or progress to chronic stage.Results:A total of 100 patients with a mean age of 43.80±12.63 yr (range 18-70); 62 males and 38 females were studied. All had bites on lower limbs. A total of 86 patients arrived in the hospital within 24 h, and 14 arrived after 24 h. Oliguria was found in 60, bleeding tendencies in 64, haemodynamic instability noted - tachycardia in 86. Systolic blood pressure (BP) was <120 mm Hg in 68 and BP was not recordable in four patients. Twelve patients were in stage III kidney disease and needed haemodialysis. Of the 100 cases of snakebite-induced acute kidney failure, 86 recovered and six died. On follow up, after six months eight patients developed chronic kidney failure.Interpretation & conclusions:A cascade of events tends to occur in severe haemotoxic envenomation such as bleeding disorders, hypotension/circulatory shock, intravascular haemolysis, disseminated intravascular coagulation and acute respiratory disease syndrome (ARDS). The findings of this study showed that early hospitalization, quick antisnake venom administration and adequate supporting care provided promising results.

Clinical and Laboratory Profile of Snake Bite Envenomation: A Crosssectional Observational Study at a Tertiary Care Center

“…Systolic blood pressure (BP) was <120 mm Hg in 68 and BP was not recordable in four patients. 18 In the present study, 14 out of 56 patients (25%) developed AKI and 11 out of 14 patients (78.5%) who had AKI required haemodialysis. These results were similar to the results reported by Jayakrishnanan M P et al which showed occurrence of AKI in 25% patients.…”

“…Pulimaddi R found similar trend in reporting to hospital where 86 out of 100 patients arrived in the hospital within 24h, and 14 arrived after 24h. 18 The main examination findings in the present study were local rise in temperature, local tenderness, lymph node enlargement, swelling crossing proximal joint, compartmental syndrome, cellulitis and necrosis. Various neurotoxic signs were ptosis, ophthalmoplegia and dysphagia.…”

“…On follow up, after six months eight patients developed chronic kidney failure. 18 Mortality is mainly due to haemotoxic envenomation. Hospital arrival after 24 hrs of bite, oliguria, mechanical ventilation and presence of leucocytosis at presentation were also associated with higher mortality.…”

Chronic kidney failure following lancehead bite envenoming: a clinical report from the Amazon region

“…One of the main issues in regard to snakebite-induced AKI is that after an apparent recovery in victims, it may progress to CKD. There are very few studies that monitored snakebite-induced AKI among the victims over longer periods of time to evaluate the risk of AKI progressing to CKD [28,[43][44][45]. The inherent limitations of these studies include a lack of information on renal function of patients prior to their envenoming incident, the identity of the perpetrating snake species, standardized follow-up programs, standardized methods for determining the severity of initial kidney injury, and differences in interventions made during the acute phase of envenoming.…”

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

“…However, it is likely that the combination of inflammatory and hemorrhagic syndromes impacted kidney function also in some non AKI patients. Clinical hemorrhages, uncoagulable blood, reduced hemoglobin, hyperleukocytosis and/or thrombocytopenia were observed during AKI (Table 3) and were generally significantly higher in AKI patients [20,45,50,[52][53][54][55][56].…”