Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Saudi J Kidney Dis Transpl. 2021 Jan-Feb;32(1):146-156. doi: 10.4103/1319-2442.318516.
Snake bite is an important cause for acute kidney injury (AKI) in the tropics and the victims are often otherwise healthy young adults without conventional risk factors for chronic kidney disease (CKD). Available literature on long-term outcomes of AKI -snake envenomation is limited, with only two small retrospective studies with follow-up periods of two years or less. In a hospital-based prospective and retrospective follow-up study, all consecutive adult patients who developed AKI and discharged alive were recruited in the prospective group and for retrospective analysis, we retrieved medical records of patients hospitalized with snake bite from the digitized medical records. Clinical and biochemical characteristics during hospitalization and on follow-up were collected. We recruited 193 patients with snake bite and AKI in a prospective (140) and a retrospective (53) group. Of the 193 AKI patients, 162 (84%) had estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m at the time of discharge from hospital and at follow-up (n = 171) 29 (16.9%) had eGFR<60 mL/min/1.73 m. Of the 116 patients with follow-up beyond one year, 30 (26%) had CKD. Overall 26 to 28% of patients went on to develop CKD depending on the duration of follow-up. Only very few (1.16%) patients progressed to ESRD. This is the largest follow-up study so far on snake bite-related AKI and provides further evidence that snake bite-associated AKI causes CKD on long-term follow-up. Older age, diabetes, severe AKI, and inadequate anti-snake venom administration were risk factors for the development of CKD on follow-up.
蛇咬伤是热带地区急性肾损伤（AKI）的重要原因，受害者通常是没有慢性肾脏病（CKD）传统危险因素的健康年轻成年人。关于 AKI-蛇咬伤的长期结局的现有文献有限，仅有两项小的回顾性研究随访期不超过两年。在一项基于医院的前瞻性和回顾性随访研究中，前瞻性组纳入了所有连续发生 AKI 并存活出院的成年患者，回顾性分析中，我们从数字化病历中检索了因蛇咬伤住院患者的病历。收集了住院期间和随访期间的临床和生化特征。我们前瞻性地（140 例）和回顾性地（53 例）纳入了 193 例 AKI 患者。在 193 例 AKI 患者中，162 例（84%）出院时和随访时（n=171）肾小球滤过率（eGFR）<60mL/min/1.73m，116 例患者随访时间超过 1 年，其中 30 例（26%）患有 CKD。根据随访时间的不同，总体上有 26%至 28%的患者发展为 CKD。只有极少数（1.16%）患者进展为 ESRD。这是迄今为止关于蛇咬伤相关 AKI 的最大随访研究，进一步证明蛇咬伤相关 AKI 在长期随访中会导致 CKD。年龄较大、糖尿病、严重 AKI 和抗蛇毒血清治疗不充分是随访时发生 CKD 的危险因素。
