ஜர்னல் ஆஃப் நெப்ராலஜி & தெரபியூட்டிக்ஸ்

Renal Complications Following Snake Bite Envenomation

Abstract

Mohammed Al-Homrany 1*, Haider Omer1 and Abdulmalik Alhomrany

Snakebite is a common medical emergency and occupational hazards particularly in tropical areas. Viper bites are more common than other poisonous snakebites in humans. The World Health Organization has estimated that there are approximately 1,25,000 deaths among 2,50,000 poisonous snake bites worldwide every year, of which India accounts for 10,000 deaths. Acute kidney Injury (AKI) is an important consequence of snakebite and its proper supportive management after the anti-venom administration is of utmost importance, for a good patient outcome. Renal involvement following snakebite envenomation has not been explored in Saudi Arabia. This is a retrospective study which was carried out at Aseer Central Hospital, a tertiary and referral hospital located in the southern part of Saudi Arabia where envenomation with snake is common medical health problem. The aim of the study is to determine the frequency of renal involvement following envenomation with snake and to determine the risk factors that contribute to the development of such complications. 134 cases of snakebites were identified during the 5-year period (100 male patients and 34 females). The mean age was 30 ± 19 y. Hematuria was seen in 19.7% and mild proteinuria was observed in 39.4%of the cases. Acute Kidney Injury (AKI) occurred in 17 cases (12.7%) and supportive renal replacement therapy was required in 4 cases. The cause of renal failure was based mainly on clinical ground: 6 cases due to pre-renal (volume loss due to bleeding), 10 due to tubulo-interstitial lesions and one case had heavy proteinuria and hematuria and glomerulonephritis was suspected. Full recovery was seen in 15 cases (88.2%) and partial recovery with permanent damage was observed in 2 cases (11.8%) after follow up for 24 months. The most important risk factors of development of AKI are older age, duration of symptoms before treatment initiated i.e. the late presentation to hospital and the abnormal coagulation in the form of disseminated intravascular coagulation. In conclusion, this study concludes that acute kidney injury occurs in 12.7% of the victims of snakebite and hemodialysis and a supportive treatment appear to be the mainstay of the therapy in the cases which are complicated by renal failure.