Albuquerque Polianna Lemos Moura Moreira, Paiva José Hicaro Hellano Gonçalves Lima, Martins Alice Maria Costa, Meneses Gdayllon Cavalcante, da Silva Geraldo Bezerra, Buckley Nicholas, Daher Elizabeth De Francesco
University of Fortaleza (Unifor), Fortaleza, Ceará, Brazil.
Toxicological Information and Assistance Center, Instituto Doutor Jose Frota Hospital, Fortaleza, Ceará, Brazil.
J Venom Anim Toxins Incl Trop Dis. 2020 Jul 10;26:e20190076. doi: 10.1590/1678-9199-JVATITD-2019-0076. eCollection 2020.
are one of the most common medically important snakes found in Latin America. Its venom is predominantly hemotoxic and proteolytic, which means that local lesion (edema and redness) and hemorrhagic symptoms are recurrent in envenoming by this snake. Although hemorrhage is usually the major cause of death, snakebite-related acute kidney injury is another potentially fatal clinical complication that may lead to chronic kidney disease. The present review highlights the main studies on venom-related acute kidney injury, including observational, cross-sectional, case-control and cohort human studies available up to December 2019. The following descriptors were used according to Medical Subject Headings (MeSH): on Medline/Pubmed and Google Scholar "acute kidney injury" "kidney disease" ""; on Lilacs and SciELO "kidney disease" "acute kidney injury" "". Newcastle-Ottawa quality assessment scale was used to appraise the quality of the cross-sectional and cohort studies included. The selection of more severe patients who looked for health care units and tertiary centers is a risk of bias. Due to the methodological heterogeneity of the studies, a critical analysis of the results was performed based on the hypothesis that the design of the included studies influences the incidence of acute kidney injury. Fifteen human studies (total participants 4624) were included according to stablished criteria. The coagulation abnormalities (hemorrhagic symptoms, abnormal fibrinogen and activated partial thromboplastin time) were associated with acute kidney injury in the most recent studies reported. The findings observed in this review provide up-to-date evidence about the acute kidney injury pathogenesis following syndrome. Studies pointed out that coagulation abnormalities comprise the major pathway for acute kidney injury development. This review may improve patient management by primary healthcare providers, allowing earlier diagnosis and treatment of venom-related acute kidney injury.
是拉丁美洲发现的最常见的具有重要医学意义的蛇类之一。其毒液主要具有血液毒性和蛋白水解性，这意味着局部损伤（水肿和发红）和出血症状在被这种蛇咬伤中毒时会反复出现。虽然出血通常是主要死因，但蛇咬伤相关的急性肾损伤是另一种可能致命的临床并发症，可能导致慢性肾病。本综述重点介绍了关于毒液相关急性肾损伤的主要研究，包括截至2019年12月的观察性、横断面、病例对照和队列人体研究。根据医学主题词表（MeSH）使用了以下描述词：在Medline/Pubmed和谷歌学术上搜索“急性肾损伤”“肾病”；在Lilacs和SciELO上搜索“肾病”“急性肾损伤”。使用纽卡斯尔-渥太华质量评估量表来评估纳入的横断面和队列研究的质量。选择前往医疗保健单位和三级中心就诊的病情更严重的患者存在偏倚风险。由于研究的方法学异质性，基于纳入研究的设计会影响急性肾损伤发生率这一假设对结果进行了批判性分析。根据既定标准纳入了15项人体研究（总参与者4624人）。在最近报道的研究中，凝血异常（出血症状、纤维蛋白原异常和活化部分凝血活酶时间异常）与急性肾损伤相关。本综述中观察到的结果提供了关于综合征后急性肾损伤发病机制的最新证据。研究指出，凝血异常是急性肾损伤发展的主要途径。本综述可能会改善初级医疗保健提供者对患者的管理方式，从而实现对毒液相关急性肾损伤的早期诊断和治疗。
