Acute renal failure following poisonous snakebite.

Area of Science:

• Nephrology
• Toxicology
• Pathology

Background:

• Snakebite envenomation is a significant health concern, often leading to systemic complications.
• Acute renal failure (ARF) is a serious consequence of snakebite, necessitating a deeper understanding of its pathogenesis.

Purpose of the Study:

• To investigate the incidence and clinical features of ARF in human snakebite patients.
• To evaluate the direct effects of viperide venoms on renal structure and function in a primate model.

Main Methods:

• Clinical and hematological evaluation of 157 snakebite patients, with renal histopathology in 35.
• Administration of lethal and sublethal doses of viperide venom to subhuman primates to assess renal and systemic effects.

Main Results:

• ARF occurred in 45 of 157 patients, with bilateral renal cortical necrosis (BRCN) having a higher mortality rate than acute tubular lesions (ATL).
• Lethal venom doses in primates caused shock, DIC, and hemolysis but no immediate renal damage.
• Sublethal venom doses in primates led to increased serum creatinine and renal lesions, suggesting direct nephrotoxicity.

Conclusions:

• ARF in snakebite is multifactorial, with hypotension, hemolysis, and DIC as contributing factors.
• Direct cytotoxic effects of viperide venom on the kidney are implicated in the pathogenesis of ARF following snakebite.