Snakebite-associated acute kidney injury in South Asia: narrative review on epidemiology, pathogenesis and management

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 119; no. 6; pp. 648 - 664
• Main Authors: Alvitigala, Bhawani Yasassri, Gooneratne, Lallindra Viranjan, Gnanathasan, Christeine Ariaranee, Wijewickrama, Eranga Sanjeewa
• Format: Journal Article
• Language: English
• Published: England 05.06.2025
• Subjects: Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Acute Kidney Injury - therapy; Animals; Antivenins - therapeutic use; Asia - epidemiology; Asia, Southern; Humans; Renal Dialysis; Snake Bites - complications; Snake Bites - epidemiology; Snake Bites - therapy; Asia; Asia, Southern; chronic kidney disease; acute kidney injury; renal histology; nephrotoxic; snakebite; South Asia
• ISSN: 0035-9203; 1878-3503; 1878-3503
• DOI: 10.1093/trstmh/trae077

Snakebite-associated acute kidney injury (AKI) poses a significant health burden in the South Asia region, resulting in considerable morbidity and mortality. Multiple factors contribute to the pathogenesis of AKI following snakebites, including hypotension, intravascular haemolysis, disseminated intravascular coagulation, rhabdomyolysis, thrombotic microangiopathy (TMA) and direct nephrotoxicity. Clinical features manifest as anuria, oliguria, haematuria, abdominal pain and hypertension. Diagnosis is supported by elevated serum creatinine levels and urine output monitoring. Renal histology studies revealed a spectrum of lesions, including acute tubular necrosis, renal cortical necrosis, glomerulonephritis and TMA. Management strategies centre around timely administration of antivenom, fluid and electrolyte balance and dialysis to improve renal outcomes. While dialysis has demonstrated efficacy in reducing AKI-related mortality rates, the use of fresh frozen plasma and therapeutic plasma exchange may be the subject of some controversy. Understanding the pathophysiological link between coagulopathy, TMA and AKI is important for tailoring effective treatment approaches. Species-specific randomized controlled trials are imperative to evaluate targeted interventions. In tackling the complexities of snakebite-associated AKI and chronic kidney disease, a multidisciplinary approach integrating clinical management with rigorous research efforts is essential. This collaborative endeavour aims to confront the challenges posed by these conditions and improve patient outcomes in the affected regions.