Dineshkumar T, Dhanapriya J, Sakthirajan R, Thirumalvalavan K, Kurien A A, Balasubramaniyan T, Gopalakrishnan N
Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.
Indian J Nephrol. 2017 Mar-Apr;27(2):161-164. doi: 10.4103/0971-4065.196936.
Snake bite is mainly an occupational hazard and causes serious health problems in rural India. Acute kidney injury (AKI) occurs in 5-30% cases. Renal pathologic findings include acute tubular necrosis, cortical necrosis, interstitial nephritis, glomerulonephritis, and vasculitis. Thrombotic microangiopathy (TMA) occurrence after a snake bite is reported rarely. Here, we present two patients who developed TMA after viper bite treated with hemodialysis and plasmapheresis. Renal biopsy showed fibrin thrombi in glomeruli and arterioles with cortical necrosis. One patient progressed to end-stage renal disease and other was lost to follow-up. TMA should be considered as a possible pathogenesis of AKI after snake bite. The role of plasma exchanges in snake bite TMA is yet to be defined.
蛇咬伤主要是一种职业危害，在印度农村地区会引发严重的健康问题。5%至30%的病例会出现急性肾损伤（AKI）。肾脏病理表现包括急性肾小管坏死、皮质坏死、间质性肾炎、肾小球肾炎和血管炎。蛇咬伤后血栓性微血管病（TMA）的发生鲜有报道。在此，我们报告两名蝰蛇咬伤后发生TMA的患者，他们接受了血液透析和血浆置换治疗。肾活检显示肾小球和小动脉中有纤维蛋白血栓形成，并伴有皮质坏死。一名患者进展为终末期肾病，另一名患者失访。TMA应被视为蛇咬伤后AKI的一种可能发病机制。血浆置换在蛇咬伤TMA中的作用尚待明确。
