Chronic kidney failure following lancehead bite envenoming: a clinical report from the Amazon region

Abstract

Background: 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. Case presentation: 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. Conclusion: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.

Chronic health effects and cost of snakebite

“…Other neurological conditions with long-lasting impact such as visual and hearing impairment, paresthesia at the bite site, and persistence of hemiparesis or hemiplegia due to cerebrovascular events at the time of acute envenoming have also been reported ( Spano et al, 2014 ; Jayawardana et al, 2018 ). Chronic renal failure requiring haemodialysis has been reported in some victims of snakebite who had developed acute kidney injury following the bite ( Naqvi, 2016 ; Pucca et al, 2020 ). Establishing causality is challenging as most of these reports provide no information regarding the victims’ renal function prior to envenoming, and therefore the problem is neglected.…”

Crotalus Durissus Ruruima: Current Knowledge on Natural History, Medical Importance, and Clinical Toxinology

“…In Venezuela's case, the Laboratorios BIOTECFAR, a public producer maintained by Universidad Central de Venezuela, responsible for the production of antivenoms in the country, has experienced difficulty maintaining continuous production in the last years (158). The shortage of antivenom in Venezuelan is suggested as the cause of patients seeking treatment in Brazil after severe snakebites (166).…”

Acute kidney injury caused by venomous animals: inflammatory mechanisms

“…Either bites or stings of venomous animals are considered a public health problem in tropical countries. Acute kidney injury (AKI) is the main complication resulting from accidents caused by animal toxins and it is related to higher mortality rates [ 1 , 2 ]. In the Brazilian Amazon, mortality rate from snakebites has been estimated at 0.51%, which is 10 times higher than the estimated global average [ 2 ].…”

“…Acute kidney injury (AKI) is the main complication resulting from accidents caused by animal toxins and it is related to higher mortality rates [ 1 , 2 ]. In the Brazilian Amazon, mortality rate from snakebites has been estimated at 0.51%, which is 10 times higher than the estimated global average [ 2 ]. Bothrops , Crotalus , Lachesis and Micrurus are the most important genus of snakes from the medical point of view in Brazil, with genus Bothrops (pit vipers) being responsible for most of the bites (90%) and deaths related to snakes (0.3%) in the Brazilian Amazon [ 2 ].…”

“…In the Brazilian Amazon, mortality rate from snakebites has been estimated at 0.51%, which is 10 times higher than the estimated global average [ 2 ]. Bothrops , Crotalus , Lachesis and Micrurus are the most important genus of snakes from the medical point of view in Brazil, with genus Bothrops (pit vipers) being responsible for most of the bites (90%) and deaths related to snakes (0.3%) in the Brazilian Amazon [ 2 ]. AKI incidence can reach up to 50% in victims of bites or stings of venomous animals [ 1 , 2 ].…”