Snake bite continues to be a significant cause of Acute kidney injury (AKI) and subsequent Chronic Kidney Disease (CKD) in Asia.Methods: A retrospective observational study. Data of all snake bite induced AKI admissions collected from 2014 to 2018. Data related to clinical profile, AKI severity, renal and patient outcomes and kidney biopsy findings were analyzed by descriptive statistics. Results: There were 3105 patients with AKI in the study period. Of them, 208 patients had AKI due to snake bite. There were 128 (61.5%) males. The mean age was 44.7 +/-0.94 years. Mean bite to anti venom interval was 7.59 +/-1.55 hours (0.5 -96 hours). Toxicity profile included limb cellulitis in 86(40.4%) patients, hemotoxicity in 60(28.1%), neurotoxicity in 33(15.5%) and rhabdomyolysis in 34(15.5%). At presentation, 128 patients (81%) were in AKIN stage 3, 33(17.4%) were in stage 2 and 3(1.57%) were in stage 1. Dialysis was required in 142 patients (69.2%): hemodialysis in 138(67.3%) and peritoneal dialysis in 4(1.9%).Complete renal recovery (discharge creatinine <1.5 mg/dl) was seen in 128 patients (66.3%), partial renal recovery in 33(17%) and end stage renal disease in 19(9.8%). Mortality was 6.7%. Renal biopsy was done in 50 patients which revealed Acute tubular injury (ATI) in 18 (36%), Acute interstitial nephritis (AIN) in 12(24%), thrombotic microangiopathy (TMA) in 4(8%), Cortical necrosis in 8 (16%), ATI with pigment cast in 5(10%), ATI with AIN in 3 (6%). Conclusions: Snake bite accounted for 6.7% of all AKI in our center. Eighty one percent patients presented in AKIN stage 3, probably due to referral bias. Renal replacement therapy was required in 69.2% patients. ESRD was the outcome in 9.8% patients and 17% had partial renal recovery, who are at risk of developing CKD. Most common pathology in biopsy was acute tubular injury followed by acute interstitial nephritis. All patients with TMA and cortical necrosis progressed to CKD.
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