Renal ultrastructure in acute tubular necrosis following Russell's viper envenomation.

Electron microscopic examination of renal biopsies from nine patients who developed renal failure after Russell's viper bite showed glomerular mesangial hypercellularity, vascular endothelial swelling, tubular epithelial necrosis and shedding, acellular segments of tubular basement membrane and an interstitial infiltrate composed of mast cells, eosinophils, lymphocytes and plasma cells. These cells showed many close contacts with each other and with fibroblasts. Severe vascular and tubular lesions were also present in the medulla. These abnormalities and other reported clinical and laboratory investigations in this condition, suggest that the primary lesion is a reversible intravascular coagulation with secondary ischaemic tubular damage. The inflammatory response in the interstitium is probably initiated by a release of antigens from damaged tubules.