Pushpalatha Avunoori, Itagi Afreen Begum H, Vamshidhar Immadi S, Rani S S Sabitha, Kalpana Medala, Vidya Ganji
Department of General Medicine, Government Medical College, Bhadradri Kothagudem, Telangana, India.
Department of Physiology, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India.
J Family Med Prim Care. 2024 Nov;13(11):5301-5305. doi: 10.4103/jfmpc.jfmpc_784_24. Epub 2024 Nov 18.
Snake bite is a well-known occupational hazard amongst farmers, plantation workers, and other outdoor workers and results in much morbidity and mortality throughout the world. The complications related to kidneys are observed in most patients with snake bites admitted to a hospital. The current study aimed to study the renal involvement in patients with snake bites with reference to clinical features and the time of onset of acute renal failure.
A prospective clinical study of 68 patients of snake bite was done to know the clinical profile and outcome in Gandhi Hospital Secunderabad and cases were particularly looked for development of acute kidney injury. Later each case was studied and investigated with respect to onset, clinical features, course in the hospital, need for renal replacement therapy including dialysis, and mortality due to AKI. Patients were followed up till discharge or death. They were treated as per protocol.
The incidence of AKI was 29.1%. Common signs and symptoms were fang mark (100%), swelling (91.2%), tenderness (91.2%), bleeding manifestations (79.4%) oliguria (26.47%), anuria (5.8%), and haematuria (8.8%). Hypotension was present in 73%, which may be the cause of AKI. All the AKI patients showed coagulation abnormalities in the form of prolonged BT, CT, PT, and aPTT. Thrombocytopenia was seen in 29.4%. All the AKI patients were given ASV for 2 to 3 days. The mean ASV vials used in the present study is 15 ± 5. Hemodialysis was done in 29.4% of patients.
The cause of AKI in snakebite was multifactorial in origin. Bleeding and hypotension were among the important causes. Thrombocytopenia was significantly related to clinical bleeding. The type of snakebite is an important factor in the development of AKI and Russell's viper bite is more commonly associated with it. AKI is usually associated with oliguria and generally occurs within 48 hours.
蛇咬伤是农民、种植园工人和其他户外工作者中广为人知的职业危害，在全球范围内导致大量发病和死亡。在大多数入院的蛇咬伤患者中都观察到与肾脏相关的并发症。本研究旨在参照临床特征和急性肾衰竭的发病时间，研究蛇咬伤患者的肾脏受累情况。
对68例蛇咬伤患者进行了一项前瞻性临床研究，以了解塞康德拉巴德甘地医院的临床概况和预后情况，并特别关注急性肾损伤的发生情况。随后，对每例病例的发病情况、临床特征、在医院的病程、包括透析在内的肾脏替代治疗需求以及急性肾损伤导致的死亡率进行了研究和调查。对患者进行随访直至出院或死亡。他们按照方案进行治疗。
急性肾损伤的发生率为29.1%。常见的体征和症状有牙痕（100%）、肿胀（91.2%）、压痛（91.2%）、出血表现（79.4%）、少尿（26.47%）、无尿（5.8%）和血尿（8.8%）。73%的患者出现低血压，这可能是急性肾损伤的原因。所有急性肾损伤患者均表现出凝血异常，表现为出血时间、凝血时间、凝血酶原时间和活化部分凝血活酶时间延长。29.4%的患者出现血小板减少。所有急性肾损伤患者均接受抗蛇毒血清治疗2至3天。本研究中使用的抗蛇毒血清平均瓶数为15±5。29.4%的患者进行了血液透析。
蛇咬伤导致急性肾损伤的原因是多因素的。出血和低血压是重要原因。血小板减少与临床出血显著相关。蛇咬伤的类型是急性肾损伤发生的一个重要因素，罗素蝰蛇咬伤与之更为常见。急性肾损伤通常与少尿相关，一般在48小时内发生。
