Acute Interstitial Nephritis Following Snake Envenomation: A Single-Center Experience

Priyamvada, P S; Shankar, Vijay; Srinivas, Bheemanathi Hanuman; Rajesh, N G; Parameswaran, Sreejith

doi:10.1016/j.wem.2015.12.009

Cited by 7 publications

(23 citation statements)

References 9 publications

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“…AIN was considered to be a rare after snake bite but according to recent studies AIN after snake bite is not uncommon[39,40]. AIN accounted for 5.7%-11.9% of snakebite-related AKI.…”

Section: Discussionmentioning

confidence: 99%

“…AIN accounted for 5.7%-11.9% of snakebite-related AKI. All patients had severe envenomation at presentation[39,40], very high ASV requirement[39] and had prolonged renal failure[39,40]. Kidney biopsy found a mixed infiltrate composed of predominantly lymphocytes, with variable proportions of other cells including eosinophils neutrophils and plasma cells.…”

Section: Discussionmentioning

confidence: 99%

“…Kidney biopsy found a mixed infiltrate composed of predominantly lymphocytes, with variable proportions of other cells including eosinophils neutrophils and plasma cells. The reason for development of this pathology is not clear, but direct venom related effects possibly lead to development of the interstitial inflammation via various cytokines, mediators and adhesions molecules[39,40]. AIN was found to be reversible with corticosteroids therapy[40].…”

Section: Discussionmentioning

confidence: 99%

“…The reason for development of this pathology is not clear, but direct venom related effects possibly lead to development of the interstitial inflammation via various cytokines, mediators and adhesions molecules[39,40]. AIN was found to be reversible with corticosteroids therapy[40]. However, the long-term outcome was found to be worse as compared with those who did not have AIN, as majority patient developed chronic kidney disease (CKD) on follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with patchy cortical necrosis show delayed and partial recovery of renal function but those with diffuse cortical necrosis require regular maintenance dialysis and eventual renal transplantation[41]. RCN has been observed in 27 (24%) kidney biopsies out of total of 112 kidney biopsies carried out in patients of snake bite-induced AKI from India and Pakistan[9,28,39,40,42,43]. None had RCN on biopsy in two studies[39,40].…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathological spectrum of snake bite-induced acute kidney injury from India

Vikrant¹,

Jaryal²,

Parashar³

2017

WJN

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AIMTo study the clinico-pathological spectrum of snake bite-induced acute kidney injury (AKI).METHODSA 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.RESULTSOne 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).CONCLUSIONAKI 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.

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“…AIN was considered to be a rare after snake bite but according to recent studies AIN after snake bite is not uncommon[39,40]. AIN accounted for 5.7%-11.9% of snakebite-related AKI.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Clinicopathological spectrum of snake bite-induced acute kidney injury from India

Vikrant¹,

Jaryal²,

Parashar³

2017

WJN

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Snake bite associated with acute kidney injury

et al. 2021

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Acute kidney injury (AKI) is a well-known life-threatening systemic effect of snake envenomation which commonly happens secondary to snake bites from families of Viperidae and Elapidae. Enzymatic toxins in snake venom result in injuries to all kidney cell types including glomerular, tubulo-interstitial and kidney vasculature. Pathogenesis of kidney injury due to snake envenomation includes ischaemia secondary to decreased kidney blood flow caused by systemic bleeding and vascular leakage, proteolytic degradation of the glomerular basement membrane by snake venom metalloproteinases (SVMPs), deposition of microthrombi in the kidney microvasculature (thrombotic microangiopathy), direct cytotoxic action of venom, systemic myotoxicity (rhabdomyolysis) and accumulation of large amounts of myoglobin in kidney tubules. Clinical features of AKI include fatigue, loss of appetite, headache, nausea, vomiting, oliguria and anuria. Monitoring of blood pressure, fluid balance, serum creatinine, blood urea nitrogen and serum electrolytes is useful in managing AKI induced by snake envenomation. Early initiation of anti-snake venom and early diagnosis of AKI are always desirable. Biomarkers which will help in early prediction of AKI are being explored, and current studies suggest that urinary clusterin, urinary neutrophil gelatinase-associated lipocalin, and serum cystatin C may play an important clinical role in the future. Apart from fluid and electrolyte management, kidney support including early and prompt initiation of kidney replacement therapy when indicated forms the bedrock in managing snake biteassociated AKI. Long-term follow-up is important because of chances of progression towards CKD.

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Animal Toxins

Bolon¹,

Heinz-Taheny²,

Yeung³

et al. 2023

Haschek and Rousseaux's Handbook of Toxicologic Pathology, Volume 3

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Acute Interstitial Nephritis Following Snake Envenomation: A Single-Center Experience

Abstract: AIN after snake bite is not uncommon. AIN needs to be considered in patients with persistent renal failure after snake envenomation. Identifying this complication is of utmost importance because of the potentially reversible nature.

Cited by 7 publications

References 9 publications

Clinicopathological spectrum of snake bite-induced acute kidney injury from India

Clinicopathological spectrum of snake bite-induced acute kidney injury from India

Snake bite associated with acute kidney injury

Animal Toxins

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