Abstract
Either bites or stings of venomous animals comprise relevant public health problems in tropical countries. Acute kidney injury (AKI) induced by animal toxins is related to worse prognostic and outcomes. Being one the most important pathways to induce AKI following envenoming due to animal toxins, inflammation is an essential biological response that eliminates pathogenic bacteria and repairs tissue after injury. However, direct nephrotoxicity (i.e. apoptotic and necrotic mechanisms of toxins), pigmenturia (i.e. rhabdomyolysis and hemolysis), anaphylactic reactions, and coagulopathies could contribute to the renal injury. All these mechanisms are closely integrated, but inflammation is a distinct process. Hence, it is important to improve our understanding on inflammation mechanisms of these syndromes to provide a promising outlook to reduce morbidity and mortality. This literature review highlights the main scientific evidence of acute kidney injury induced by bites or stings from venomous animals and their inflammatory mechanisms. It included observational, cross-sectional, case-control and cohort human studies available up to December 2019. Descriptors were used according to Medical Subject Headings (MeSH), namely: “Acute kidney injury” or “Venom” and “Inflammation” on Medline/Pubmed and Google Scholar; “Kidney disease” or “Acute kidney injury” on Lilacs and SciELO. The present review evidenced that, among the described forms of renal inflammation, it can occur either directly or indirectly on renal cells by means of intravascular, systemic and endothelial hemolysis, activation of inflammatory pathway, as well as direct action of venom cytotoxic components on kidney structures.
Highlights
Either bites or stings of venomous animals are considered a public health problem in tropical countries
Acute kidney injury (AKI) is the main complication resulting from accidents caused by animal toxins and it is related to higher mortality rates [1, 2]
Eight articles were excluded because: (i) the article did not address any aspect about venom from bees, scorpions, Lonomia or snakes (n = 1), (ii) the article was a case report on an accident with venom without definite specification about the venom (n = 1), (iii) the articles were reviews about accident reports with bee stings in children (n = 2), and (iv) the articles dealt with positive results in using bee venom as medication (n = 4)
Summary
Either bites or stings of venomous animals are considered a public health problem in tropical countries. Upon contact with the bloodstream, the toxin activates immune and inflammatory mechanisms that exacerbate the expression of cytokines and stimulate coagulation factors resulting in hemoglobin degradation and pigmenturia formation [5]. These compounds come into contact with renal parenchyma and cause intratubular obstruction and direct toxicity, corroborating the decrease in glomerular filtration rate and renal failure [6]. This review aims at highlighting the main evidence on inflammatory and oxidative pathophysiological mechanisms of AKI induced by venomous animal bites or stings while contributing to the early identification of AKI by the multidisciplinary health team
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