Poisoning and Envenomation Induced Acute Kidney Injury: A Hospital-Based Study

Most cases of acute kidney injury (AKI) in the Indian subcontinent are community-acquired. Some causes of AKI like poisonings are unique to the local demographics. This study examined the clinical features, spectrum, and outcomes of AKI in patients with poisoning and evaluated the predictors of mortality.

This was a prospective observational study conducted in patients admitted to Jawaharlal Nehru Medical College, Aligarh with an alleged history of poisoning orsnake bite. Relevant history, laboratory tests, mode of treatment, and outcome were recorded for all patients who were followed up after 3 months post discharge.

During the study period, 394 patients were admitted with a provisional diagnosis of poisoning/snake bite analyzed, of whom 56 (14.2%) developed AKI. Final data analysis was done for 51 patients as 5 patients were lost to follow up. Paraquat poisoning was the most common cause of AKI, seen in 12 patients, followed by methanol in 9 patients. Hemodialysis was required in 29 (56.8%) patients. Complete recovery was seen in 33 (64.7%) patients, and 14 patients (27.5%) died during the acute phase of the illness. Late presentation to the hospital and presence of shock (mean arterial pressure <65 mmHg) on presentation were found to be associated with adverse outcomes (mortality/failure of return of renal function at 3 months). The most common cause of death was septic shock seen in 8 patients.

This study, which is probably the first from North India, highlights the fact that cases of poisoning/envenomation-related AKI contribute to a sizeable amount of morbidity/mortality.