ACUTE KIDNEY INJURY CAUSED BY Crotalus AND Bothrops SNAKE VENOM: A REVIEW OF EPIDEMIOLOGY, CLINICAL MANIFESTATIONS AND TREATMENT

Abstract

SUMMARYOphidic accidents are an important public health problem due to their incidence, morbidity and mortality. An increasing number of cases have been registered in Brazil in the last few years. Several studies point to the importance of knowing the clinical complications and adequate approach in these accidents. However, knowledge about the risk factors is not enough and there are an increasing number of deaths due to these accidents in Brazil. In this context, acute kidney injury (AKI) appears as one of the main causes of death and consequences for these victims, which are mainly young males working in rural areas. Snakes of the Bothrops and Crotalus genera are the main responsible for renal involvement in ophidic accidents in South America. The present study is a literature review of AKI caused by Bothrops and Crotalus snake venom regarding diverse characteristics, emphasizing the most appropriate therapeutic approach for these cases. Recent studies have been carried out searching for complementary therapies for the treatment of ophidic accidents, including the use of lipoic acid, simvastatin and allopurinol. Some plants, such as Apocynaceae, Lamiaceae and Rubiaceae seem to have a beneficial role in the treatment of this type of envenomation. Future studies will certainly find new therapeutic measures for ophidic accidents.

Effects of Mikania glomerata Leaf Extract on Experimental Bothropoides jararaca Envenomation in Wistar Rats

“…Envenomation symptoms were consistent with previous reports of bothropic events, in which cytolysins were responsible for most clinical symptoms, including local inflammation, edema, pain, and necrosis [8,12,19]. Early edema and tissue degradation occurs mainly due to proteolytic and vasculotoxic effects [1,15] associated with hyaluronidase, phospholipase A2, and esterase actions, related to alterations in membrane permeability and release of vasoactive agents [4]. Coagulation disturbances are secondary to thrombin-related consequences and factor X activation, leading to consumption of coagulation factors as was observed in some animals in the current study [1,17].…”

“…Ophidic accidents are a problem in many parts of the world, especially in tropical and subtropical areas, with most cases caused by the Bothrops genus [1,[15][16][17].…”

“…Bothropic venom, as a mixture of compounds, causes severe local and systemic reactions related to proteolytic, vasculotoxic, coagulant and/or hemorrhagic effects [1,13,15]. The above reactions are responsible for swelling, edema, necrosis, respiratory distress, disseminated intravascular coagulation, acute renal failure, and death [4,8,12,19].…”

“…Anti-ophidic serum is the only validated treatment [4] for bothropic envenomation, but it needs to be accompanied by essential supportive measures such as hypovolemia correction, broad-spectrum antibiotics, tetanus prophylaxis, analgesia, and local management [1].…”

“…Many plants have been used to ameliorate the effects of snakebite [1]. Among them, Mikania glomerata commonly known as "guaco," a plant found in the Brazilian Atlantic Forest, possesses multiple medical properties associated with its constituent coumarins and their derivativesterpenes, phytosterols, and flavonoids [14].…”