Ramasamy S1, Sudhaselvi S2, Rajkumar V3, Balamurugan S4, Vasif Mayan M. C5, Shankar R6
Snakebites and accidents caused by venomous arthropods are important public health problem. Envenomation by snakebite, independently of the species responsible for the bite, enforces medical emergencies since different organs and tissues can be affected at the same time. The hypothesis for pathogenesis of venom-induced AKI includes both a direct cytotoxic action of the venom on different renal structures and a secondary response of the whole organism resulting from systemic envenomation. The aim of the study is to assess the early predictors for acute kidney injury due to snakebite by comparing it with the patients who had not developed acute kidney injury after the snakebite.
MATERIALS AND METHODS
A prospective comparative study was undertaken at the Government Medical College Hospital, Salem, during the period of April 2015-March 2016. A total of 115 patients were included in the study in which 42 patients were having AKI due to snakebite and 73 patients were without AKI after snakebite. Haematological and biochemical investigations were performed in all patients, including haemoglobin, complete and differential leukocyte counts, platelet count, peripheral blood smear, bleeding and clotting times, Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT), blood urea, serum creatinine, serum electrolytes, liver function tests and urine examination.
Thrombocytopenia and albuminuria, which is to be considered as the major early marker for acute kidney injury among snakebite patients was found to be present in 85.7% and 100% in our patients with AKI whereas it was only 1.3% and 4.1% respectively among the patients without AKI and the difference was found to be statistically significant (p<.05). The survival rate was higher among the patients without AKI when compared to the patients with AKI and the difference is statistically significant (p<.05).
Early detection of AKI due to snakebite should be assessed by testing for the platelet count and the urine albumin at the time of admission and appropriate treatment for it would help to reduce the mortality significantly.