Acute kidney injury after snakebite accident treated in a Brazilian tertiary care centre

• Published in: Nephrology (Carlton, Vic.) Vol. 19; no. 12; pp. 764 - 770
• Main Authors: Albuquerque, Polianna L. M. M., Silva Junior, Geraldo B., Jacinto, Camilla N., Lima, Julianna B., Lima, Caroline B., Amaral, Yago S., Veras, Maria do Socorro B., Mota, Rosa M. S., Daher, Elizabeth F.
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.12.2014
• Subjects: acute kidney injury; Acute Kidney Injury - diagnosis; Acute Kidney Injury - etiology; Acute Kidney Injury - physiopathology; Acute Kidney Injury - therapy; Adolescent; Adult; Antivenins - therapeutic use; Brazil; Chi-Square Distribution; complications; Female; Humans; Kidney - physiopathology; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; ophidic accident; Recovery of Function; Renal Dialysis; Retrospective Studies; Risk Factors; Snake Bites - complications; Snake Bites - mortality; Snake Bites - therapy; Snake Venoms; snakebite; Tertiary Care Centers; Time Factors; Time-to-Treatment; Treatment Outcome; Young Adult; Brazil; risk factors; acute kidney injury; complications; ophidic accident; snakebite
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.12327

Aim Acute kidney injury (AKI) is one of the main causes of morbidity and mortality in cases of envenomation by venomous snakes. The present study was carried out to investigate the clinical and laboratory manifestations in accidents with venomous snakes and the risk factors associated with AKI in these accidents. Methods A retrospective study was carried out with patients victims of snakebite admitted to a reference centre. AKI was defined according to the RIFLE and AKIN criteria. Results A total of 276 patients were included, of which 230 (83.7%) were males. AKI was observed in 42 cases (15.2%). The mean genus involved in the accidents was Bothrops (82.2%). Mean age of patients with AKI was higher than in patients without AKI (43 ± 20 vs. 34 ± 21 years, P = 0.015). The time elapsed between the accident and medical care was higher in the AKI group (25 ± 28 vs. 14 ± 16h, P = 0.034), as well as the time elapsed between the accident and the administration of antivenom (30.7 ± 27 vs. 15 ± 16 h, P = 0.01). Haemodialysis was required in 30% of cases and complete renal function recovery was observed in 54.8% of cases at hospital discharge. There were four deaths, none of which had AKI. Factors associated with AKI were haemorrhagic abnormalities (P = 0.036, OR = 6.718, 95% CI: 1.067–25.661) and longer length of hospital stay (P = 0.004, OR = 1.69, 95% CI 1.165–2.088). Conclusion Acute kidney injury is an important complication of snakebite accidents, showing low mortality, but high morbidity, which can lead to partial renal function recovery. Summary at a Glance The manuscript describes the epidemiology and clinical features of AKI among victims of snake bite in Brazil. Importantly, a significant proportion did not show full renal functional recovery.