Thrombotic Microangiopathy, Hemolytic Uremic Syndrome, and Thrombotic Thrombocytopenic Purpura Following Hump-nosed Pit Viper (Genus: Hypnale) Envenoming in Sri Lanka

Rathnayaka, R.M.M.K. Namal; Ranathunga, PE Anusha Nishanthi; Kularatne, S.A.M.

doi:10.1016/j.wem.2018.10.003

Cited by 28 publications

(37 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Seven-thousand-and-forty-two articles underwent abstract screening, with 223 full text reviews, and 72 studies selected (Fig 1). These included 31 single case reports [13,15,16,[22][23][24], 31 case series [8,9,14,17,[25][26][27], nine cohort studies [11,[84][85][86][87][88][89][90][91], and one nested case control study (Table 1) [92]. Eighteen studies contained completely or partially duplicated cases which were merged (S5 Table) [9,11,14,23,26,41,60,[66][67][68]75,76,81,[84][85][86]88,92].…”

Section: Resultsmentioning

confidence: 99%

“…Some studies have proposed TPE as an effective treatment for the acute kidney injury (AKI) of TMA following snakebite [23][24][25]. Associations between TMA following snakebite and HUS have arisen primarily given the apparent renal predominant end organ injury of both disorders [25][26][27]. Whilst TPE is commonly used during the initial presentation of HUS, it is usually unsuccessful.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Snakebite associated thrombotic microangiopathy: a systematic review of clinical features, outcomes, and evidence for interventions including plasmapheresis

et al. 2020

View full text Add to dashboard Cite

Snakebite is a neglected tropical disease with significant morbidity and mortality. Thrombotic microangiopathy (TMA) is an important but poorly understood complication of snakebite associated with acute kidney injury (AKI). Numerous treatments have been attempted based on limited evidence. We conducted a systematic review of TMA following snakebite using a pre-determined case definition of blood film red cell schistocytes or histologically diagnosed TMA. The search strategy included major electronic databases and grey literature. We present a descriptive synthesis for the outcomes of AKI, dialysis free survival (DFS), other end-organ damage, overall survival, and interventions with antivenom and therapeutic plasmapheresis (TPE). This study was prospectively registered with PROSPERO (CRD42019121436). Seventy-two studies reporting 351 cases were included, predominantly small observational studies. Heterogeneity for study selection, design, reporting and outcomes were observed. The commonest envenoming species were hump-nosed vipers (Hypnale spp.), Russell’s viper (Daboia russelii) and Australian brown snakes (Pseudechis spp.). The prevalence of TMA was at least 5.4% in proven and probable Hypnale bites, and 10–15% of Australian elapid envenomings, AKI occurred in 94% (293/312) of TMA cases, excluding case reports. The majority of cases with AKI required dialysis. Included prospective and retrospective cohort studies reporting interventions and renal outcomes showed no evidence for benefit from antivenom or TPE with respect to DFS in dialysis dependant AKI. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment for quality of accumulated evidence for interventions was low. The major complication of TMA following snakebite is AKI. AKI improves in most cases. We found no evidence to support benefit from antivenom in snakebite associated TMA, but antivenom remains the standard of care for snake envenoming. There was no evidence for benefit of TPE in snakebite associated TMA, so TPE cannot be recommended. The quality of accumulated evidence was low, highlighting a need for high quality larger studies.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Snakebite associated thrombotic microangiopathy: a systematic review of clinical features, outcomes, and evidence for interventions including plasmapheresis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The thrombotic microangiopathy presented a clinical picture similar to the one of hemolytic uremic syndrome (HUS) 2 , i.e., AKI, thrombocytopenia and microangiopathic hemolytic anemia (MAHA). Although many studies have reported the relationship between TMA and the venom-induced consumption coagulopathy (VICC), TMA in snakebite may occur without VICC 10 , 11 . VICC is characterized by prolonged clotting times caused by activation of the coagulation cascade by prothrombin, thrombin-like enzymes and factor X activators present in the venom 2 , 12 , which resolves after the toxins neutralization.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic microangiopathy due to Bothrops erythromelas: a case report in Northeast Brazil

Mota

Albuquerque

Júnior

et al. 2020

Rev. Inst. Med. trop. S. Paulo

View full text Add to dashboard Cite

show abstract

“…TMA has two classic variants, namely hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (Namal Rathnayaka et al, 2019). TMA can also be seen in many clinical scenarios such as positive antiphospholipid antibody in lupus patients, preeclampsia, malignant hypertension, and atypical HUS.…”

Section: Evs In Tmamentioning

confidence: 99%

Extracellular vesicles mediate cellular interactions in renal diseases—Novel views of intercellular communications in the kidney

Zhang

Liu

2021

Journal Cellular Physiology

View full text Add to dashboard Cite

The kidney is a complicated and important internal organ receiving approximately 20% of the cardiac output and mediates numerous pathophysiologic actions. These include selectively filtering macromolecules of the blood, exquisite reclaimation of electrolyctes, urine concentration via an elegant osmotic mechanism, and excretion of an acid load. In addition, the renal tubules carry out secretory functions and produce hormones and cytokines. The kidney receives innervation and hormonal regulation. Therefore, dysfunction of the kidney leads to retention of metabolic waste products, and/or significant proteinuria and hematuria. In the past several decades, the role of extracellular vesicles (EVs) in intercellular communications, and the uptake of EVs by recipient cells through phagocytosis and endocytosis have been elucidated. The new knowledge on EVs expands over the classical mechanisms of cellular interaction, and may change our way of thinking of renal pathophysiology in the subcellular scale. Based on some ultrastructural discoveries in the kidney, this review will focus on the role of EVs in intercellular communications, their internalization by recipient cells, and their relationship to renal pathology.

show abstract

Thrombotic Microangiopathy, Hemolytic Uremic Syndrome, and Thrombotic Thrombocytopenic Purpura Following Hump-nosed Pit Viper (Genus: Hypnale) Envenoming in Sri Lanka

Cited by 28 publications

References 28 publications

Snakebite associated thrombotic microangiopathy: a systematic review of clinical features, outcomes, and evidence for interventions including plasmapheresis

Snakebite associated thrombotic microangiopathy: a systematic review of clinical features, outcomes, and evidence for interventions including plasmapheresis

Thrombotic microangiopathy due to Bothrops erythromelas: a case report in Northeast Brazil

Extracellular vesicles mediate cellular interactions in renal diseases—Novel views of intercellular communications in the kidney

Contact Info

Product

Resources

About