A STUDY ON HEMOTOXIC SNAKE ENVENOMATION INDUCED ACUTE KIDNEY INJURY AND ITS OUTCOMES: A PROSPECTIVE FOLLOW UP STUDY
Main Article Content
Keywords
Snakebite, Public Health Concern, Anti-Snake Venom (ASV), WHO, Acute Kidney Injury (AKI, CKD Risk after AKI, Incidence of CKD, Follow-up Nephrology Care.
Abstract
Background: Snakebite is a critical public health issue, particularly in rural regions of tropical and subtropical countries, affecting farmers, plantation workers, construction workers, snake charmers, hunters, and migrant populations. Urbanization and deforestation have exacerbated the problem, making snakebite a significant health concern. In India, snakebite-related mortality is alarmingly high, necessitating urgent attention. The World Health Organization (WHO) estimates that 81,000–138,000 deaths occur annually worldwide due to snakebites, with approximately three times as many survivors suffering from amputations and permanent disabilities. The Million Death Study (MDS) in India has documented cause-specific mortality patterns, highlighting the importance of early administration of Anti-Snake Venom (ASV) to reduce mortality and morbidity in envenomation cases.
Methods: This prospective follow-up study focuses on acute kidney injury (AKI) induced by hemotoxic snake envenomation and its long-term outcomes. The study population included patients diagnosed with AKI following snakebite, with an emphasis on evaluating the incidence of chronic kidney disease (CKD) post-recovery. Data were collected on risk factors such as multiple AKI episodes, baseline CKD, and the severity of AKI. Follow-up nephrology care was assessed to determine its impact on long-term renal outcomes.
Results: The study revealed a significant correlation between AKI and CKD, with evidence indicating that even AKI patients with apparent full recovery are at an independent risk for developing CKD later in life. Risk factors such as multiple AKI episodes, pre-existing CKD, and the severity of AKI were identified as reliable predictors of CKD progression.
Conclusion: The findings highlight the long-term renal risks associated with hemotoxic snake envenomation-induced AKI. Even after apparent recovery, AKI survivors are at heightened risk for CKD, emphasizing the need for systematic follow-up nephrology care to mitigate long-term complications.
References
[2] Suraweera W, Warrell D, Whitaker R, Menon G, Rodrigues R, Fu SH, et al. Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study. Elife 2020;9:e54076.
[3] Waiddyanatha S, Silva A, Siribaddana S, Isbister GK. Long-term Effects of Snake Envenoming. Toxins 2019;11(4):193.
[4] Whitaker R. Snakes of India: The Field Guide [Internet]. Chennai: Draco Books 2004: p. 506. Available from: http://archive.org/details/snakesofindiafie0000whitaker
[5] Ralph R, Faiz MA, Sharma SK, Ribeiro I, Chappuis F. Managing snakebite. BMJ 2022;e057926.
[6] Waikhom R, Sircar D, Patil K, Bennikal M, Gupta SD, Pandey R. Long-term renal outcome of snake bite and acute kidney injury: a single-center experience. Ren Fail 2012;34(3):271-4.
[7] Priyamvada PS, Jaswanth C, Zachariah B, Haridasan S, Parameswaran S, Swaminathan RP. Prognosis and long-term outcomes of acute kidney injury due to snake envenomation. Clin Kidney J 2020;13(4):564-70.
[8] George A, Tharakan VT, Solez K. Viper bite poisoning in India: a review with special reference to renal complications. Ren Fail 1987;10(2):91-9.
[9] Sharma N, Chauhan S, Faruqi S, Bhat P, Varma S. Snake envenomation in a north Indian hospital. Emerg Med J EMJ 2005;22(2):118-20.
[10] George T, Toms A, Fenn B, Kumar V, Kavitha R, Georgy J, et al. Renal outcomes among snake-envenomed patients with acute kidney injury in southern India. Natl Med J India 2019;32(1):5.
[11] Kumar M, Arcot Thanjan M, Gopalakrishnan N, Jeyachandran D, Thanigachalam D, et al. Snake envenomation-induced acute kidney injury: prognosis and long-term renal outcomes. Postgrad Med J 2022;98(1158):264–8.
[12] Ariga K, Dutta TK, Haridasan S, Pillai Puthenpurackal PS, Harichandrakumar KT, Parameswaran S. Chronic Kidney Disease after Snake Envenomation Induced Acute Kidney Injury. Saudi J Kidney Dis Transplant 2021;32(1):146-56.
[13] Patil T, Bansod Y. Snake bite-induced acute renal failure: A study of clinical profile and predictors of poor outcome. Ann Trop Med Public Health 2012;5(4):335.
[14] Vikrant S, Jaryal A, Parashar A. Clinicopathological spectrum of snake bite- induced acute kidney injury from India. World J Nephrol 2017;6(3):150-61.
[15] Ali K, Pathak I, Sehrawat S. Pattern of snakebite cases evaluated at a tertiary care hospital. Indian J Forensic Community Med 2020;5(4):215-7.
[16] Athappan G, Balaji MV, Navaneethan U, Thirumalikolundusubramanian P. Acute renal failure in snake envenomation: a large prospective study. Saudi J Kidney Dis Transplant Off Publ Saudi Cent Organ Transplant Saudi Arab 2008;19(3):404-10.
[17] Harshavardhan L, Lokesh AJ, Tejeshwari HL, Halesha BR, Metri SS. A study on the acute kidney injury in snake bite victims in a tertiary care centre. J Clin Diagn Res 2013;7(5):853-6.
[18] Dharod MV, Patil TB, Deshpande AS, Gulhane RV, Patil MB, Bansod YV. Clinical predictors of acute kidney injury following snake bite envenomation. North Am J Med Sci 2013;5(10):594-9.
[19] Mukhopadhyay P, Mishra R, Mukherjee D, Mishra R, Kar M. Snakebite mediated acute kidney injury, prognostic predictors, oxidative and carbonyl stress: a prospective study. Indian J Nephrol 2016;26(6):427-33.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Seetaram N.K.
Associate Professor, Department of General Medicine, KMCRI, Hubli, Karnataka, India.
Dr. Gayathri B.H.
Associate Professor, Department of General Medicine, KMCRI, Hubli, Karnataka, India.
Dr. Vishwanath Patil
Assistant Professor, Department of General Medicine, KMCRI, Hubli, Karnataka, India.
Dr. Naveen Bhosle
Senior Resident, Department of General Medicine, KMCRI, Hubli, Karnataka, India.