Snake-bite-induced Acute Kidney Injury.

OBJECTIVE

To describe the clinical spectrum and outcome of patients presenting to a tertiary care kidney center, developing acute kidney injury (AKI) after snake-bite.

STUDY DESIGN

An observational study.

PLACE AND DURATION OF STUDY

Nephrology Department, Sindh Institute of Urology and Transplantation (SIUT), Karachi, from January 1990 to December 2014.

METHODOLOGY

All patients coming to SIUTidentified as having AKI after snake-bite during the study period were included. AKI was defined according to RIFLE criteria with sudden rise in creatinine or decline in urine output or both. Demographics, clinical presentation, laboratory profile, and final outcome was noted.

RESULTS

During the studied period, 115 cases of AKI, secondary to snake-bite, were registered at this institution. Median age of patients was 35.92 ±15.04 (range: 6 - 70) years and male to female ratio was 1.6:1. Time from bite and referral to this hospital ranged from 2 to 28 days (mean: 8.77 ±5.58 days). Oligo-anuria was the most common presentation, being found in 98 (93.90%) patients. Bleeding diathesis was reported in 75 (65.21%) patients on presentation. All patients had normal sized, non-obstructed kidneys on ultrasonography, with no previous comorbids. Renal replacement therapy (RRT) was required in 106 (92.17%) patients. Complete recovery was seen in 59 (51.30%), while 15 (13.04%) patients expired during acute phase of illness, 4 (3.47%) developed CKD, 11 (9.56%) required dialysis beyond 90 days, and 26 (22.60%) were lost to long-term follow-up.

CONCLUSION

Snake-bite, leading to multiple complications including renal failure and death, is a major health issue in tropical countries. Late referral of these patients to specialized centres results in undesirable outcome.