• Bothrops snake
• Acute kidney injury
• Pediatric kidney failure
• Risk factors
• Snake bite

• acute interstitial nephritis
• capillary leak syndrome
• corticosteroid
• plasma exchange
• thrombotic microangiopathy

• South Asia
• acute kidney injury
• chronic kidney disease
• nephrotoxic
• renal histology
• snakebite

• acute kidney injury
• toxin-induced nephropathy
• diagnostic markers

• Acute Kidney Injury/etiology
• Acute Kidney Injury/epidemiology
• Acute Kidney Injury/diagnosis
• Snake Bites/complications
• Snake Bites/epidemiology
• Humans
• Republic of Korea/epidemiology
• Male
• Female
• Middle Aged
• Retrospective Studies
• Creatinine/blood
• Adult
• Aged
• Animals
• Case-Control Studies
• Incidence
• Viperidae

• BCRI23032 Chonnam National University Hospital Biomedical Research Institute
• NRF-2022R1A2C2013209 National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT)

• Acute kidney injury
• Daboia siamensis venom
• Inflammatory cytokines
• Oxidative stress
• Rabbits
• Venom fractions

• Acute cortical necrosis
• Acute kidney injury
• Kidney histopathology
• Snakebite envenomation
• Thrombotic microangiopathy

• Humans
• Snake Bites/complications
• Snake Bites/epidemiology
• Snake Bites/diagnosis
• Kidney
• Acute Kidney Injury/diagnosis
• Thrombotic Microangiopathies/diagnosis
• India/epidemiology
• Necrosis

• Hump-nosed pit viper
• Hypnale spp.
• chronic kidney disease
• long-term effects
• snakebites

• Animals
• Female
• Humans
• Male
• Acute Kidney Injury/epidemiology
• Acute Kidney Injury/etiology
• Blood Coagulation Disorders/etiology
• Crotalinae
• Renal Insufficiency, Chronic/complications
• Snake Bites/complications
• Snake Bites/epidemiology
• Sri Lanka/epidemiology
• Viper Venoms
• Prospective Studies

• Snakebite
• acute kidney injury
• albuminuria
• chronic kidney disease
• envenoming

• Antivenins/therapeutic use
• Humans
• Practice Guidelines as Topic
• Primary Health Care/standards
• Snake Bites/therapy

• Acute kidney injury
• Acute renal failure
• Poisoning
• Snake envenomation
• Toxicology
• Tropical

• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/etiology
• Acute Kidney Injury/therapy
• Biomarkers/blood
• Blood Urea Nitrogen
• Creatinine/blood
• Electrolytes/blood
• Humans
• Renal Replacement Therapy
• Snake Bites/complications
• Snake Bites/diagnosis
• Snake Bites/therapy

• Antivenins/therapeutic use
• Cost of Illness
• Disabled Persons
• Humans
• Neglected Diseases/complications
• Snake Bites/complications
• Snake Bites/economics
• Snake Bites/therapy
• Survivors

• acute renal failure
• chronic renal failure
• toxicology

Snakebite envenoming can be a life-threatening condition, for which emergency care is essential. The Bothrops (lancehead) genus is responsible for most snakebite-related deaths and permanent loss of function in human victims in Latin America. Bothrops spp. venom is a complex mixture of different proteins that are known to cause local necrosis, coagulopathy, and acute kidney injury. However, the long-term effects of these viper envenomings have remained largely understudied.

Here, we present a case report of a 46-years old female patient from Las Claritas, Venezuela, who was envenomed by a snake from the Bothrops genus. The patient was followed for a 10-year period, during which she presented oliguric renal failure, culminating in kidney failure 60 months after the envenoming.

In Latin America, especially in Brazil, where there is a high prevalence of Bothrops envenoming, it may be relevant to establish long-term outpatient programs. This would reduce late adverse events, such as chronic kidney disease, and optimize public financial resources by avoiding hemodialysis and consequently kidney transplantation.

• Bothrops
• Chronic kidney disease
• Long-term effects
• Renal failure
• Snakebite

• long-term effects
• snakebites
• traditional Chinese medicine
• venom

• Animals
• Brain Diseases/drug therapy
• Brain Diseases/etiology
• Cerebral Infarction/drug therapy
• Cerebral Infarction/etiology
• Drugs, Chinese Herbal/administration & dosage
• Drugs, Chinese Herbal/therapeutic use
• Humans
• Hypopituitarism/drug therapy
• Hypopituitarism/etiology
• Intracranial Hemorrhages/drug therapy
• Intracranial Hemorrhages/etiology
• Medicine, Chinese Traditional
• Migraine Disorders/drug therapy
• Migraine Disorders/etiology
• Renal Insufficiency, Chronic/drug therapy
• Renal Insufficiency, Chronic/etiology
• Snake Bites/complications
• Taiwan

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.

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.

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).

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.

• acute kidney injury
• capillary leak syndrome
• long-term renal outcomes
• prognosis
• snake envenomation

• chronic
• delayed
• envenoming
• long-term
• snakebite

Urine β2 microglobulin (β2m) is a validated marker to diagnose sepsis and toxin-related acute kidney injury (AKI). In the current study, we used urine β2m as a potential marker to identify persistent tubular dysfunction following a clinical recovery from snake venom–related AKI.

A total of 42 patients who developed AKI following hemotoxic envenomation were followed up for a period of 6 months. Urine albumin excretion, estimated glomerular filtration rate (eGFR), and urine β2m levels were measured at 2 weeks, 3 months, and 6 months following discharge.

At the end of 6 months of follow-up, 6 patients (14.3 %) progressed to chronic kidney disease (CKD) (eGFR < 60 ml and/or urine albumin excretion > 30 mg/d). The urine β2m levels were 1590 μg/l (interquartile range [IQR] 425–5260), 610 μg/l (IQR 210–1850), 850 μg/l (IQR 270–2780) at 2 weeks, 3 months, and 6 months, respectively (P = 0.020). The levels of urine β2m in the study population at the end of 6 months remained significantly higher compared with the levels in healthy control population (850 μg/l [IQR 270–2780] vs. 210 μg/l [IQR 150–480]; P = 0.001). The proportion of patients with urine β2m levels exceeding the 95th percentile of control population (>644 µg/l) during the 3 follow-up visits were 70.7% (n = 29), 48.8 % (n = 20), and 51.2% (n = 21). Similar trends were noticed in a sensitivity analysis, after excluding patients with CKD.

Urine β2m levels remain persistently elevated in approximately half of the individuals who recover from AKI due to snake envenomation.

• acute kidney injury
• beta 2 microglobulin

Acute Kidney Injury (AKI) is the main systemic complication and cause of death in viperid envenomation. Although there are hypotheses for the development of AKI, the mechanisms involved are still not established. The aim of this study was to evaluate the clinical-laboratorial-epidemiological factors associated with AKI in victims of Bothrops sp envenomation. This is an observational study carried out at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. AKI was defined according to the guidelines of the Acute Kidney Injury Network (AKIN). Among the 186 patients evaluated, AKI was observed in 24 (12.9%) after 48 hours of admission. Stage I was present in 17 (70.8%) patients, II in 3 (12.5%) and III in 4 (16.7%). Epidemiological characterization showed predominance of men, occurrence in rural areas, aged between 16–60 years, feet as the most affected anatomical region, and time to medical assistance less than 3 hours. Hypertension and diabetes were the comorbidities identified. Most of the accidents were classified as moderate, and clinical manifestations included severe pain, mild edema, local bleeding and headache. Laboratory results showed blood uncoagulability, hypofibrinogenemia, leukocytosis, increase of creatine kinase, and high lactate dehydrogenase levels. Multivariate analysis showed an association with high LDH levels [AOR = 1.01 (95% CI = 1.01–1.01, p<0.002)], local bleeding [AOR = 0.13 (95%CI = 0.027–0.59, p<0.009)], and the presence of comorbidities [AOR = 60.96 (95%CI = 9.69–383.30; p<0.000)]. Herein, laboratory markers such as high LDH levels along with local bleeding and comorbidities may aid in the diagnosis of AKI.

To study the clinico-pathological spectrum of snake bite-induced acute kidney injury (AKI).

A 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.

One 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).

AKI 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.

• Acute kidney injury
• Acute tubular necrosis
• Acute interstitial nephritis
• Envenomation
• Hemolysis
• Renal cortical necrosis
• Rhabdomyolysis
• Snake bite

• Asia
• Latin America
• acute kidney injury
• animal venom
• emerging issues
• tropical infectious diseases