Probable chronic renal failure caused by Lonomia caterpillar envenomation

Schmitberger, Poliana Abrantes; Fernandes, Tássia Clara; Santos, Robson Corrêa; Assis, Rafael Campos de; Gomes, Andréia Patrícia; Siqueira, Priscila Karina; Vitorino, Rodrigo Roger; Mendonça, Eduardo Gomes de; Oliveira, Maria Goreti de Almeida; Siqueira-Batista, Rodrigo

doi:10.1186/1678-9199-19-14

Cited by 10 publications

(7 citation statements)

References 28 publications

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“…Envenomed victims display systemic hemorrhage secondary to intravascular disseminated coagulation [ for review see 1,2] . Frequently, the clinical profile evolves to acute kidney injury (AKI), which is the main cause of death following this type of envenomation [3–5] . In experimental models, L .…”

Section: Introductionmentioning

confidence: 99%

Renal and vascular effects of kallikrein inhibition in a model of Lonomia obliqua venom-induced acute kidney injury

et al. 2019

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Background Lonomia obliqua venom is nephrotoxic and acute kidney injury (AKI) is the main cause of death among envenomed victims. Mechanism underlying L . obliqua -induced AKI involves renal hypoperfusion, inflammation, tubular necrosis and loss of glomerular filtration and tubular reabsorption capacities. In the present study, we aimed to investigate the contribution of kallikrein to the hemodynamic instability, inflammation and consequent renal and vascular impairment Methodology/Principal findings Addition of L . obliqua venom to purified prekallikrein and human plasma in vitro or to vascular smooth muscle cells (VSMC) in culture, was able to generate kallikrein in a dose-dependent manner. Injected in rats, the venom induced AKI and increased kallikrein levels in plasma and kidney. Kallikrein inhibition by aprotinin prevented glomerular injury and the decrease in glomerular filtration rate, restoring fluid and electrolyte homeostasis. The mechanism underlying these effects was associated to lowering renal inflammation, with decrease in pro-inflammatory cytokines and matrix metalloproteinase expression, reduced tubular degeneration, and protection against oxidative stress. Supporting the key role of kallikrein, we demonstrated that aprotinin inhibited effects directly associated with vascular injury, such as the generation of intracellular reactive oxygen species (ROS) and migration of VSMC induced by L . obliqua venom or by diluted plasma obtained from envenomed rats. In addition, kallikrein inhibition also ameliorated venom-induced blood incoagulability and decreased kidney tissue factor expression Conclusions/Significance These data indicated that kallikrein and consequently kinin release have a key role in kidney injury and vascular remodeling. Thus, blocking kallikrein may be a therapeutic alternative to control the progression of venom-induced AKI and vascular disturbances.

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Section: Introductionmentioning

confidence: 99%

Renal and vascular effects of kallikrein inhibition in a model of Lonomia obliqua venom-induced acute kidney injury

et al. 2019

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“…reported case of a patient whose Lonomia caterpillar sting went unrecognized until a week after the accident ended with progression to stage V chronic renal disease. 12 Recent research has focused on the specific mechanism of injury caused by Lonomia species. A study found that the venom of L obliqua causes cytoskeleton rearrangement and migration in vascular smooth muscle cells (VSMCs) by inducing formation of reactive oxygen species through activation of nicotinamide adenine dinucleotide phosphate oxidase.…”

Section: Wwwmdedgecom/dermatologymentioning

confidence: 99%

What’s Eating You? Caterpillars

Ellis¹

2021

Cutis

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“…In many cases, symptomatic treatment was given with corticosteroids and antihistamines, given the inflammatory and anaphylactic manifestations presented by the patients. However, the treatment for erucism consists of washing the affected area with cold water, applying cold compresses, infiltration with 2% lidocaine and topical corticosteroids (10).…”

Section: Physiopathology Of the Acute Renal Injury Secondary To Lonommentioning

confidence: 99%

“…To make an adequate diagnosis, paraclinical tests must be performed; an essential test are the coagulation times, which are altered in all cases with an important prolongation, secondary to a hemorrhagic process with a fibrinolytic pathophysiological basis. Prothrombin time (PT) and partial thromboplastin time (PTT) values are usually variable, due to the initial characteristics of the patient's coagulation system (10,11,31). However, it has been observed that the values in L. obliqua envenomation are always above the control, since the larva has two procoagulant proteins that affect the coagulation cascade in the common pathway, lopap prothrombin activator, and losac factor X activator; this is the reason why both PT and PTT are altered (13,32,33).…”

Section: Diagnosismentioning

confidence: 99%

Acute Kidney Injury Secondary to Lonomia envenomation. Case Report and Literature Review

Arsanios¹,

Quintero²,

Sarmiento³

et al. 2020

Univ. Med.

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Introduction The envenomation by Lonomia species mainly occur in rural areas. The main symptom of this condition is an alteration in the clotting times and hemorrhage. However, acute kidney injury is been also identified in some case reports. Therefore, it should not be disregarded and to understand the pathophysiological mechanism, diagnosis and treatment of this clinical feature results necessary in order to expand awareness and to prevent further medical complications and death. Materials and Methods We present a case report and scoping review of the literature to characterize patients with acute kidney injury secondary to Lonomia envenomation by a case report and describing the pathophysiology, diagnosis, treatment and prognosis of patients suffering from this condition. The information was obtained from 4 databases: Medline, Embase, LILACs and Ovid. We used the following search strategy: (((“Acute Kidney Injury” [Mesh]) AND “lonofibrase” [Supplementary Concept]) OR lonomy accident) OR lonomia. Results We identified ten case reports of Lonomia spp. Envenomation, nine of them were caused by L. obliqua and one by L. achelous. A cohort study that included 37 patients who were exposed to the L. obliqua venom was also included. All patients were adults, lived in the countryside and developed acute kidney injury. Conclusions Acute kidney injury has been identified as one important clinical feature of the Lonomia envenomation. The development of this condition is mediated by various pathophysiological mechanisms. To perform an adequate diagnosis, coagulation times, fibrinogen levels, hemogram, kidney function and urinalysis should be done. The definitive treatment depends on the type of envenomation. The prognosis for these patients is not well described yet. However, our patient had a good response to the described management given.

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Probable chronic renal failure caused by Lonomia caterpillar envenomation

Cited by 10 publications

References 28 publications

Renal and vascular effects of kallikrein inhibition in a model of Lonomia obliqua venom-induced acute kidney injury

Renal and vascular effects of kallikrein inhibition in a model of Lonomia obliqua venom-induced acute kidney injury

What’s Eating You? Caterpillars

Acute Kidney Injury Secondary to Lonomia envenomation. Case Report and Literature Review

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