Clinical Practice Recommendations: Snakebite-envenomation-associated Acute Kidney Injury

Area of Science:

• Nephrology
• Toxicology
• Public Health

Background:

• Snakebite is a significant public health issue in India, causing substantial morbidity and mortality.
• Acute kidney injury (AKI) is a severe complication of snake envenomation, particularly from viperid and elapid species.
• AKI following snakebite increases the risk of developing chronic kidney disease (CKD).

Purpose of the Study:

• To develop evidence-based recommendations for recognizing, evaluating, and managing snakebite-envenomation-associated AKI (SAKI).
• To integrate global best practices with India's national treatment guidelines and resource constraints.
• To standardize care for SAKI across different medical specialties.

Main Methods:

• Literature review of PubMed, international guidelines (WHO, KDIGO), and Indian Standard Treatment Guidelines (STG).
• Expert panel deliberations to formulate recommendations based on available evidence.
• Synthesis of global and national approaches for SAKI management.

Main Results:

• Early recognition of envenomation and prompt polyvalent antisnake venom (ASV) administration are crucial.
• Protocolized monitoring of coagulation and renal function, alongside standardized kidney replacement therapy (KRT), is recommended.
• Supportive care for venom-induced consumption coagulopathy (VICC), rhabdomyolysis, and thrombotic microangiopathy (TMA) is emphasized, with special considerations for vulnerable populations.

Conclusions:

• SAKI is a preventable and treatable condition with timely interventions.
• Standardized diagnostic and therapeutic approaches aim to reduce mortality and improve renal outcomes in SAKI patients.
• Survivors of SAKI remain at risk for CKD, necessitating ongoing monitoring and management.