Nephrology and Transplant Unit, Teaching Hospital, Kandy, Sri Lanka.
Toxicon. 2012 Jul;60(1):61-5. doi: 10.1016/j.toxicon.2012.03.015. Epub 2012 Mar 26.
Hump-nosed viper (Hypnale species) bites are common in Sri Lanka and a proportion of these bites lead to coagulation abnormalities and acute kidney injury (AKI). We observed thrombotic microangiopathy (TMA) among some of these patients, but its contribution to severity of AKI and other morbidities remains unknown. Thus, we report a case series of TMA following hump-nosed viper bite addressing the complications and renal out comes in Sri Lanka. This was a prospective observational study carried out at the nephrology unit, Kandy in Sri Lanka from October 2010 to October 2011 and included 11 patients with AKI following hump-nosed viper bites. All eleven cases needed renal replacement therapy (RRT) with intermittent haemodialysis for a period of 1-5 weeks. Of them, 7 patients developed TMA with evidence of microangiopathic haemolytic anaemia (MAHA), thrombocytopenia and severe anaemia needing multiple blood transfusions. They needed longer duration of RRT (range 2-5 weeks); 2 patients developed chronic kidney disease and two died during acute stage. Autopsy study found thrombosis of micro-vessels. Thrombotic microangiopathy could be a causative pathology of AKI in hump-nosed viper bite carrying poor outcome.
在斯里兰卡，角吻蝮（Hypnale 种）咬伤较为常见，其中一部分咬伤会导致凝血异常和急性肾损伤（AKI）。我们观察到其中一些患者存在血栓性微血管病（TMA），但其对 AKI 严重程度和其他并发症的影响尚不清楚。因此，我们报告了一系列角吻蝮咬伤后发生 TMA 的病例，以探讨斯里兰卡 TMA 的并发症和肾脏结局。这是一项前瞻性观察性研究，于 2010 年 10 月至 2011 年 10 月在斯里兰卡康提的肾病科进行，共纳入 11 例角吻蝮咬伤后发生 AKI 的患者。所有 11 例患者均需要接受肾脏替代治疗（RRT），采用间歇性血液透析，持续 1-5 周。其中，7 例患者出现 TMA，表现为微血管性溶血性贫血（MAHA）、血小板减少和严重贫血，需要多次输血。他们需要更长时间的 RRT（2-5 周）；2 例患者发展为慢性肾脏病，2 例在急性期死亡。尸检研究发现微血管血栓形成。TMA 可能是角吻蝮咬伤导致 AKI 的致病病理学，预后较差。
