Snake envenomation-induced acute kidney injury: prognosis and long-term renal outcomes. Issue 1158 (10th March 2021)

• Record Type: Journal Article
• Authors: Kumar, Manoj; Arcot Thanjan, Maasila; Gopalakrishnan, Natarajan; Jeyachandran, Dhanapriya; Thanigachalam, Dineshkumar; Ramanathan, Sakthirajan
• Is Part Of: Postgraduate medical journal. Volume 98:Issue 1158(2022)
• Page Start: 264
• Page End: 268
• Publication Date: 2021-03-10
• Subjects: acute renal failure -- chronic renal failure -- toxicology; Medicine -- Periodicals; 610
• DOI: 10.1136/postgradmedj-2020-139021
• Languages: English
• ISSNs: 0032-5473

Abstract

Abstract : Background: Snake bite continues to be a significant cause of acute kidney injury (AKI) in India. There is paucity of data regarding long-term outcomes of such patients. In this study, we aim to assess the prognosis and long-term renal outcomes of such patients. Methods: We analysed the hospital records of snake envenomation-induced AKI from January 2015 to December 2018. Predictors of in-hospital mortality were assessed. Survivors were advised to visit follow-up clinic to assess their kidney function. Results: There were 769 patients with evidence of envenomation and of them, 159 (20.7%) had AKI. There were 112 (70.4%) males. Mortality occurred in 9.4% of patients. Logistic regression analysis identified shock (OR 51.949, 95% CI 4.297 to 628.072) and thrombocytopenia (OR 27.248, 95% CI 3.276 to 226.609) as predictors of mortality. Forty-three patients attended the follow-up. The mean follow-up duration was 30.4±15.23 months. Adverse renal outcomes (eGFR <60 mL/min/1.73 m 2 or new-onset hypertension (HTN) or pre-HTN or urine protein creatinine ratio >0.3) occurred in 48.8% of patients. Older age (mean age (years) 53.3 vs 42.8, p=0.004) and longer duration on dialysis (median duration (days) 11.5 vs 5, p=0.024) were significantly associated with adverse renal outcomes. Conclusions: The incidence of AKI in snake envenomation was 20.7%. The presence of shock and thrombocytopenia were associated with mortality. Adverse renal outcomes occurred in 48.8% of patients in the long term.