Early demographic and clinical predictors of developing acute kidney injury in snake bite patients: A retrospective controlled study from an Indian tertiary care hospital in North Eastern Uttar Pradesh India
Anoop Kumar, R. R. Singh, Dharmendra Uraiya, Neeraj Tripathi
Citation Information :
Kumar A, Singh RR, Uraiya D, Tripathi N. Early demographic and clinical predictors of developing acute kidney injury in snake bite patients: A retrospective controlled study from an Indian tertiary care hospital in North Eastern Uttar Pradesh India. Indian J Crit Care Med 2016; 20 (7):404-408.
Aims: This study was conducted retrospectively to define early demographic and clinical predictors for acute kidney injury (AKI) among snake bite patients at the time of hospital admission.
Materials and Methods: We analyzed 138 cases with a poisonous snake bite. Patients were classified into two groups according to the presence and absence of AKI. The data regarding clinical features and demographic profile of these patients were collected from the hospital records in a prestructured pro forma and statistically compared.
Results: Of the 138 patients of venomous snake bite, 62 developed AKI (44.92%). Patients who developed AKI were older in age. Moreover, prolonged bite to anti-snake venom (ASV) time had a significant relationship in developing AKI (P < 0.05). Among the clinical features, there was an independent positive association of AKI with abdomen pain, tenderness and vomiting, cellulitis, bleeding tendencies, myalgia, and black or brown urine (P < 0.05). Neurological features were inversely associated with renal involvement.
Conclusion: We found that marked abdominal pain, tenderness and vomiting, myalgia, black or brown urine, bite site cellulitis, bleeding tendencies, and prolonged (>2 h) bite to ASV time were significantly associated with the development of AKI in snake bite patients.
Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM, et al. Snakebite mortality in India: A nationally representative mortality survey. PLoS Negl Trop Dis 2011;5:e1018.
Patil TB, Bansod YV, Patil MB. Snake bite induced acute renal failure: A study of clinical profile and predictors of poor outcome. World J Nephrol Urol 2012;1:59-65.
Dharod MV, Patil TB, Deshpande AS, Gulhane RV, Patil MB, Bansod YV. Clinical predictors of acute kidney injury following snake bite envenomation. N Am J Med Sci 2013;5:594-9.
Athappan G, Balaji MV, Navaneethan U, Thirumalikolundusubramanian P. Acute renal failure in snake envenomation: A large prospective study. Saudi J Kidney Dis Transpl 2008;19:404-10.
Reid HA. Myoglobinuria and sea-snake-bite poisoning. Br Med J 1961;1:1284-9.
Chugh KS, Aikat BK, Sharma BK, Dash SC, Mathew MT, Das KC. Acute renal failure following snakebite. Am J Trop Med Hyg 1975;24:692-7.
Chugh KS. Snake-bite-induced acute renal failure in India. Kidney Int 1989;35:891-907.
Warrell DA. Snake venoms in science and clinical medicine 1. Russell′s viper: Biology, venom and treatment of bites. Trans R Soc Trop Med Hyg 1989;83:732-40.
Theakston RD, Phillips RE, Warrell DA, Galagedera Y, Abeysekera DT, Dissanayaka P, et al. Envenoming by the common krait (Bungarus caeruleus) and Sri Lankan cobra (Naja naja): Efficacy and complications of therapy with Haffkine antivenom. Trans R Soc Trop Med Hyg 1990;84:301-8.
Kularatne SA. Common krait (Bungarus caeruleus) bite in Anuradhapura, Sri Lanka: A prospective clinical study, 1996-98. Postgrad Med J 2002;78:276-80.
Kalantri S, Singh A, Joshi R, Malamba S, Ho C, Ezoua J, et al. Clinical predictors of in-hospital mortality in patients with snake bite: A retrospective study from a rural hospital in central India. Trop Med Int Health 2006;11:22-30.
Warrell DA. Guidelines for the clinical management of snakebites in the South East Asian regions. Southeast Asian J Trop Med Public Health 1999;30:1-84.
Jorge MT, Sano-Martins IS, Tomy SC, Castro SC, Ferrari RA, Ribeiro LA, et al. Snakebite by the bushmaster (Lachesis muta) in Brazil: Case report and review of the literature. Toxicon 1997;35:545-54.
Paul J, Dasgupta S. Early prediction of acute kidney injury by clinical features of snakebite patients at the time of hospital admission. N Am J Med Sci 2012;4:216-20.
Vanholder R, Sever MS, Erek E, Lameire N. Rhabdomyolysis. J Am Soc Nephrol 2000;11:1553-61.
Isbister GK. Snakebite doesn′t cause disseminated intravascular coagulation: Coagulopathy and thrombotic microangiopathy in snake envenoming. Semin Thromb Hemost 2010;36:444-51.
Sitprija V, Boonpucknavig V. Snake venoms and nephrotoxicity. In: Lee CV, editor. Snake Venoms. New York: Springer-Verlag Berlin Heidelberg; 1979. p. 997-1018.
