Sitprija Visith
Queen Saovabha Memorial Institute and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Nephrology (Carlton). 2006 Oct;11(5):442-8. doi: 10.1111/j.1440-1797.2006.00599.x.
There is a broad clinical spectrum of renal involvement in snakebite. Besides the local and systemic symptoms, clinical renal manifestations vary from mild proteinuria, haematuria, pigmenturia to acute renal failure. Bites by haemotoxic snakes and myotoxic snakes are the common causes of renal involvement especially acute renal failure. Therefore, renal failure is often associated with haemorrhagic diathesis, intravascular haemolysis and rhabdomyolysis. Renal pathological changes include mesangiolysis, glomerulonephritis, vasculitis, tubular necrosis, interstitial nephritis and cortical necrosis. Tubular necrosis is an important pathological counterpart of acute renal failure. Haemodynamic alterations induced by cytokines and vasoactive mediators leading to renal ischaemia are important in the pathogenesis of acute renal failure. Haemolysis, intravascular coagulation and rhabdomyolysis are important contributing factors. Direct nephrotoxicity can be induced by the venom through metalloproteases and phosphilipase A2. Immunologic mechanism plays a minor role in the pathogenesis of the renal lesion.
蛇咬伤所致肾脏损害的临床谱较广。除局部和全身症状外，临床肾脏表现从轻度蛋白尿、血尿、色素尿到急性肾衰竭不等。血循毒类蛇和肌毒类蛇咬伤是导致肾脏损害尤其是急性肾衰竭的常见原因。因此，肾衰竭常与出血倾向、血管内溶血及横纹肌溶解有关。肾脏病理改变包括系膜溶解、肾小球肾炎、血管炎、肾小管坏死、间质性肾炎及皮质坏死。肾小管坏死是急性肾衰竭重要的病理对应表现。细胞因子和血管活性介质引起的血流动力学改变导致肾缺血，在急性肾衰竭发病机制中起重要作用。溶血、血管内凝血及横纹肌溶解是重要的促成因素。毒液可通过金属蛋白酶和磷脂酶A2直接引起肾毒性。免疫机制在肾脏损害发病机制中作用较小。
