Alvitigala Bhawani Yasassri, Gooneratne Lallindra Viranjan, Gnanathasan Christeine Ariaranee, Wijewickrama Eranga Sanjeewa
Department of Pathology, Faculty of Medicine, University of Colombo, P.O. 00800, Sri Lanka.
Department of Clinical Medicine, Faculty of Medicine, University of Colombo, P.O. 00800, Sri Lanka.
Trans R Soc Trop Med Hyg. 2025 Jun 5;119(6):648-664. doi: 10.1093/trstmh/trae077.
Snakebite-associated acute kidney injury (AKI) poses a significant health burden in the South Asia region, resulting in considerable morbidity and mortality. Multiple factors contribute to the pathogenesis of AKI following snakebites, including hypotension, intravascular haemolysis, disseminated intravascular coagulation, rhabdomyolysis, thrombotic microangiopathy (TMA) and direct nephrotoxicity. Clinical features manifest as anuria, oliguria, haematuria, abdominal pain and hypertension. Diagnosis is supported by elevated serum creatinine levels and urine output monitoring. Renal histology studies revealed a spectrum of lesions, including acute tubular necrosis, renal cortical necrosis, glomerulonephritis and TMA. Management strategies centre around timely administration of antivenom, fluid and electrolyte balance and dialysis to improve renal outcomes. While dialysis has demonstrated efficacy in reducing AKI-related mortality rates, the use of fresh frozen plasma and therapeutic plasma exchange may be the subject of some controversy. Understanding the pathophysiological link between coagulopathy, TMA and AKI is important for tailoring effective treatment approaches. Species-specific randomized controlled trials are imperative to evaluate targeted interventions. In tackling the complexities of snakebite-associated AKI and chronic kidney disease, a multidisciplinary approach integrating clinical management with rigorous research efforts is essential. This collaborative endeavour aims to confront the challenges posed by these conditions and improve patient outcomes in the affected regions.
蛇咬伤相关的急性肾损伤（AKI）在南亚地区造成了重大的健康负担，导致相当高的发病率和死亡率。多种因素促成了蛇咬伤后AKI的发病机制，包括低血压、血管内溶血、弥散性血管内凝血、横纹肌溶解、血栓性微血管病（TMA）和直接肾毒性。临床特征表现为无尿、少尿、血尿、腹痛和高血压。血清肌酐水平升高和尿量监测有助于诊断。肾脏组织学研究揭示了一系列病变，包括急性肾小管坏死、肾皮质坏死、肾小球肾炎和TMA。管理策略围绕及时给予抗蛇毒血清、维持液体和电解质平衡以及进行透析以改善肾脏预后展开。虽然透析已证明在降低与AKI相关的死亡率方面有效，但新鲜冷冻血浆和治疗性血浆置换的使用可能存在一些争议。了解凝血病、TMA和AKI之间的病理生理联系对于制定有效的治疗方法很重要。必须开展针对特定物种的随机对照试验以评估靶向干预措施。在应对蛇咬伤相关的AKI和慢性肾脏病的复杂性时，将临床管理与严谨的研究工作相结合的多学科方法至关重要。这种合作努力旨在应对这些疾病带来的挑战，并改善受影响地区患者的预后。
