Acute Kidney Injury Caused by <i>Bothrops</i> Snake Venom

Abstract

Medically important venomous snakes in Latin America belong to the genus Bothrops, Crotalus, Lachesis and Micrurus. The Bothrops genus is responsible for the majority of accidents. The WHO globally estimates 2,500,000 poisonous snakebites and 125,000 deaths annually. In its last report in 2001, the Brazilian Ministry of Health accounted 359 deaths due to snakebites, of which the Bothrops genus was responsible for 185. Snake venoms cause local and systemic damage, including acute kidney injury, which is the most important cause of death among patients surviving the early effects of envenoming by the Crotalus and Bothrops genuses. Venom-induced acute kidney injury is a frequent complication of Bothrops snakebite, carrying relevant morbidity and mortality.

Acute Kidney Injury Induced by Snake and Arthropod Venoms

“…The need for dialysis ranges from 33 % to 75 % of cases (Pinho et al, 2008). AKI is mainly due to acute tubular necrosis and acute cortical necrosis and occasionally glomerulonephritis (Table 2) (Rodrigues-Sgrignolli et al, 2011). These renal pathological alterations have been attributed mainly to hemodynamic changes in response to envenomation, hemoglobinuria, intravascular clot formation and direct venom nephrotoxicity.…”

“…The main reported factors influencing AKI prevalence upon such envenomation are: the patient's age (children under 10 year of age have been shown to be more susceptible to develop AKI); the snake's age (venom composition can vary even within the same species, according to the snake's age); bite site and amount of inoculated venom; and the time elapsed until antivenom treatment. Moreover, pre-existing diseases such as hypertension, diabetes or previous nephropathies may become patients more vulnerable to the effects of venom (Rodrigues-Sgrignolli et al, 2011;Zelanis et al, 2010). Taking in consideration all the above factors, the mortality rate of Bothrops venom-induced AKI range from 13 % to 19 %.…”

Effects of Schizolobium parahyba Extract on Experimental Bothrops Venom-Induced Acute Kidney Injury

“…In Latin America, snakes of the genus Bothrops are the main cause of venomous snake accidents; the most clinically relevant species are Bothrops asper, Bothrops atrox and Bothrops jararaca [13], [14].…”

“…The venom has proteolytic, coagulant, hemorrhagic and direct nephrotoxic activities, which together cause local injury at the bite site, ranging from an inflammatory response to severe tissue necrosis and systemic manifestations, such as coagulation system disturbances that may evolve to hemorrhagic manifestations, hypotension and acute kidney injury (AKI) [13], [15], [16]. Several toxins contribute to the clinically relevant effects of the venom, including bradykinin-releasing enzymes, phospholipases A 2 (PLA 2 ), serine proteinases, metalloproteinases, l-amino oxidases, hyaluronidases, thrombin-like enzymes, factor X and prothrombin activators, toxins that stimulate or inhibit platelet function, hemorrhagins, phosphodiesterases and 5′-nucleotidases [15].…”

“…AKI is a frequent complication after Bothrops envenoming [13], [16] and is considered the main cause of death in patients who survive the first effects of the venom [13], [14], [17]. The mechanisms causing Bothrops venom-induced AKI are likely high venom concentration at the renal tissue, direct venom action on the tubular cells, hemoglobinuria, glomerular deposition of fibrin microthrombi, renal vasoconstriction, release of alarmins and oxidative stress [18]–[25].…”