Viper bite poisoning in India: a review with special reference to renal complications.

Viper bites are a significant cause of mortality in India. Acute renal failure is a common finding in cases of lethal envenomization. Coagulation abnormalities and shock are other key clinical features. Some of the renal lesions appear to reflect a direct toxic effect of venom on kidney parenchyma. Glomerular, tubular, interstitial, and vascular lesions have all been described. Experimentally, viper venom causes mesangiolysis, and this may be a significant factor in the pathogenesis of viper bite-induced glomerular disease. Treatment with antivenom is commonly used but is not supported by controlled trials. Dialysis and supportive treatment appear to be the mainstay of therapy in cases complicated by renal failure.