Sitprija V, Chaiyabutr N
Queen Saovabha Memorial Institute, Bangkok, Thailand.
J Nat Toxins. 1999 Jun;8(2):271-7.
There is a broad spectrum of renal involvement following snake envenomation. At the clinical level the renal manifestation may be absent or minimal. Mild proteinuria with abnormal urinary sediment may be observed. Significant proteinuria is uncommon. Hematuria and hemoglobinuria are seen in envenomation by vipers or crotalids, while myoglobinuria follows envenomation of sea snakes or elapids. Acute renal failure can occur in these snake bites. All renal structures can be involved. Mesangial proliferative glomerulonephritis is common. Tubular necrosis is the important pathological counterpart of acute renal failure. Three mechanisms including hemodynamic alterations, immunologic reactions, and direct nephrotoxicity are incriminated in the pathogenesis of renal lesions.
蛇咬伤后肾脏受累情况广泛。在临床层面，肾脏表现可能不存在或很轻微。可观察到轻度蛋白尿伴异常尿沉渣。大量蛋白尿并不常见。蝰蛇或响尾蛇科毒蛇咬伤可出现血尿和血红蛋白尿，而海蛇或眼镜蛇科毒蛇咬伤后会出现肌红蛋白尿。这些蛇咬伤可导致急性肾衰竭。所有肾脏结构均可受累。系膜增生性肾小球肾炎很常见。肾小管坏死是急性肾衰竭的重要病理表现。肾脏病变的发病机制涉及血流动力学改变、免疫反应和直接肾毒性这三种机制。
