Predicting acute renal failure in Bothrops snakebite patients in a tertiary reference center, Western Brazilian Amazon

Abstract

Acute Kidney Injury (AKI) is the main systemic complication and cause of death in viperid envenomation. Although there are hypotheses for the development of AKI, the mechanisms involved are still not established. The aim of this study was to evaluate the clinical-laboratorial-epidemiological factors associated with AKI in victims of Bothrops sp envenomation. This is an observational study carried out at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. AKI was defined according to the guidelines of the Acute Kidney Injury Network (AKIN). Among the 186 patients evaluated, AKI was observed in 24 (12.9%) after 48 hours of admission. Stage I was present in 17 (70.8%) patients, II in 3 (12.5%) and III in 4 (16.7%). Epidemiological characterization showed predominance of men, occurrence in rural areas, aged between 16–60 years, feet as the most affected anatomical region, and time to medical assistance less than 3 hours. Hypertension and diabetes were the comorbidities identified. Most of the accidents were classified as moderate, and clinical manifestations included severe pain, mild edema, local bleeding and headache. Laboratory results showed blood uncoagulability, hypofibrinogenemia, leukocytosis, increase of creatine kinase, and high lactate dehydrogenase levels. Multivariate analysis showed an association with high LDH levels [AOR = 1.01 (95% CI = 1.01–1.01, p<0.002)], local bleeding [AOR = 0.13 (95%CI = 0.027–0.59, p<0.009)], and the presence of comorbidities [AOR = 60.96 (95%CI = 9.69–383.30; p<0.000)]. Herein, laboratory markers such as high LDH levels along with local bleeding and comorbidities may aid in the diagnosis of AKI.

Clinical Features and Management of Snakebite Envenoming in French Guiana

“…The main involved organisms were Aeromonas hydrophila, Morganella morganii , and Bacteroides sp. These data are in concordance with the published literature [ 12 , 13 ].…”

Clinical assessment and pathophysiology of Bothrops venom-related acute kidney injury: a scoping review

“…In Brazil, Costa Rica and Panama, antivenoms are freely available for patients in all reference hospitals and health centers [61], which is an effective measure to decrease mortality. Moreover, studies have suggested a delayed time between snakebite and antivenom administration in patients with higher incidence of AKI, therefore it is important to observe the antivenom distribution chain [5,66].…”

“…However, only a few applied the AKI definition according to KDIGO, AKIN or RIFLE criteria [5,8,11,14,56,[67][68][69][70][71][72][73][74]. Data from retrospective series described a great variable in AKI incidence, 1.4 to 44.4% [5,8,11,56,[66][67][68][69][70][71][72][73][74]. Therefore, the real incidence of AKI due to Bothrops envenoming is underestimated, not only because of the ambiguity of the definition, but also the absence of notification in some rural areas [63] (Table 1).…”

Liver Transplant with a Donor after Bothropic Accident - Case Report

“…The venom has proteins capable of breaking the integrity of the vascular endothelium. The union of hemorrhagic action and coagulation disorders can cause detectable bleeds, such as bleeding gums, blood in the urine and hemorrhagic stroke, as well as other potentially lifethreatening complications [9,10].…”

“…Acute renal injury is the most common systemic complication and the leading cause of death from Viperidae poisoning [10]. Involvement of the liver by the venom of the bothropic species has also been associated with complications such as the formation of a subcapsular hematoma [15].…”