Vijeth S R, Dutta T K, Shahapurkar J
Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Am J Trop Med Hyg. 1997 Feb;56(2):168-70. doi: 10.4269/ajtmh.1997.56.168.
Viper venom is mainly hemotoxic and causes coagulation disorders. One of the serious complications of viperine bite is renal failure. Forty adult cases of viper bite with systemic envenomation were studied for renal abnormality. Renal involvement was noted in 13 (32.5%) cases, of which eight (61.5%) had primary fibrinogenolysis and five (38.5%) had disseminated intravascular coagulopathy (DIC). Eight cases (61.5%) with renal dysfunction had incoagulable blood, whereas five (38.5%) had mild coagulation abnormality; however, none of the cases with incoagulable blood who received polyvalent anti-snake venom (ASV) within 8 hr of being bitten developed renal abnormality. In the majority of cases (61.5%), renal dysfunction persisted for more than a week longer than coagulation defects despite adequate treatment. Two cases died. Renal biopsy done in three cases with renal dysfunction revealed acute tubular necrosis. We concluded that renal abnormality correlated well with the degree of coagulation abnormality when left untreated due to late arrival at the hospital. Early administration of ASV prevents renal damage however severe the coagulation abnormality. It appears that DIC is not the cause of renal dysfunction in all cases of acute renal failure, and direct toxicity caused by venom could be responsible for renal dysfunction in certain cases.
蝰蛇毒液主要具有血液毒性，可导致凝血功能障碍。蝰蛇咬伤的严重并发症之一是肾衰竭。对40例发生全身中毒的成年蝰蛇咬伤病例进行了肾脏异常情况研究。13例（32.5%）出现肾脏受累，其中8例（61.5%）发生原发性纤维蛋白溶解，5例（38.5%）发生弥散性血管内凝血（DIC）。8例（61.5%）肾功能不全的病例血液无法凝固，而5例（38.5%）有轻度凝血异常；然而，在被咬伤后8小时内接受多价抗蛇毒血清（ASV）治疗的血液无法凝固的病例中，无一例出现肾脏异常。在大多数病例（61.5%）中，尽管进行了充分治疗，但肾功能不全持续的时间比凝血缺陷长一周以上。2例死亡。对3例肾功能不全的病例进行肾活检，结果显示为急性肾小管坏死。我们得出结论，由于就医较晚未接受治疗时，肾脏异常与凝血异常程度密切相关。早期给予ASV可预防肾脏损伤，无论凝血异常多么严重。似乎在所有急性肾衰竭病例中，DIC并非肾功能不全的原因，在某些情况下，毒液引起的直接毒性可能是肾功能不全的原因。
