The kidney in tropical snakebite

Renal pathological changes were studied by renal biopsy in 31 patients bitten by tropical poisonous snakes which included seasnake (2 cases), cobra (11 cases), green-pit viper (8 cases) and Russell's viper (10 cases). Renal failure was present only in patients bitten by seasnake and Russell's viper. Glomerular mesangial proliferation was noted in the victims of cobra, green-pit viper and Russell's viper. There was deposition of IgM AND C3 in the glomerular mesangium with extension along the capillary walls. Fibrin deposition was seen in green-pit viper cases. By electron microscopy electron dense deposits were observed in the glomerular basement membrane-like matrix. Irregular thickening of the basement membrane was found in cobra cases. Vascular changes included arteritis of the interlobular artery with C3 deposition in the arterial walls in Russell's viper cases and thrombophlebitis in both green-pit viper's and Russell's viper's victims. Dense deposits of C3 in the arteriolar walls were noted in viper-bite and cobra-bite. Tubular necrosis was demonstrated in patients envenomated by green-pit viper and Russell's viper. Necrosis was severe in seasnake and Russell's viper poisoning, but was mild in green-pit viper cases.