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Thrombotic microangiopathy due to Viperidae bite: Two case reports
T Dineshkumar1, J Dhanapriya1, R Sakthirajan1
1Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.
Indian Journal of Nephrology
|March 31, 2017
Summary
Snake bites can cause acute kidney injury (AKI), a serious complication in rural India. This study highlights a rare cause of AKI: thrombotic microangiopathy (TMA) after a viper bite.
Area of Science:
- Nephrology
- Toxicology
- Pathology
Background:
- Snake bites are a significant health concern in rural India, frequently leading to acute kidney injury (AKI).
- Common renal pathologies include acute tubular necrosis, cortical necrosis, interstitial nephritis, glomerulonephritis, and vasculitis.
- Thrombotic microangiopathy (TMA) is a rare but serious complication following snake envenomation.
Observation:
- Two patients developed TMA after a viper bite.
- Treatment involved hemodialysis and plasmapheresis.
- Renal biopsies revealed fibrin thrombi in glomeruli and arterioles, alongside cortical necrosis.
Findings:
- One patient developed end-stage renal disease.
- The other patient was lost to follow-up.
- Thrombotic microangiopathy (TMA) is a potential cause of acute kidney injury (AKI) post-snake bite.
Implications:
- Thrombotic microangiopathy (TMA) should be considered in the differential diagnosis of acute kidney injury (AKI) following snake bites.
- The efficacy of plasma exchange in managing snake bite-induced TMA requires further investigation.
- This case series underscores the severe renal complications associated with snake envenomation.
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