Abstract
Acute kidney injury (AKI) following snakebite is common in developing countries and Bothrops genus is the main group of snakes in Latin America. To evaluate the pathogenic mechanisms associated with Bothrops venom nephrotoxicity, we assessed urinary and blood samples of patients after hospital admission resulting from Bothrops snakebite in a prospective cohort study in Northeast Brazil. Urinary and blood samples were evaluated during hospital stay in 63 consenting patients, divided into AKI and No-AKI groups according to the KDIGO criteria. The AKI group showed higher levels of urinary MCP-1 (Urinary monocyte chemotactic protein-1) (median 547.5 vs. 274.1 pg/mgCr; p = 0.02) and urinary NGAL (Neutrophil gelatinase-associated lipocalin) (median 21.28 vs. 12.73 ng/mgCr; p = 0.03). Risk factors for AKI included lower serum sodium and hemoglobin levels, proteinuria and aPTT (Activated Partial Thromboplastin Time) on admission and disclosed lower serum sodium (p = 0.01, OR = 0.73, 95% CI: 0.57–0.94) and aPTT (p = 0.031, OR = 26.27, 95% CI: 1.34–512.11) levels as independent factors associated with AKI. Proteinuria showed a positive correlation with uMCP-1 (r = 0.70, p < 0.0001) and uNGAL (r = 0.47, p = 0.001). FENa (Fractional Excretion of sodium) correlated with uMCP-1 (r = 0.47, P = 0.001) and uNGAL (r = 0.56, p < 0.0001). sCr (serum Creatinine) showed a better performance to predict AKI (AUC = 0.85) in comparison with new biomarkers. FEK showed fair accuracy in predicting AKI (AUC = 0.92). Coagulation abnormality was strongly associated with Bothrops venom-related AKI. Urinary NGAL and MCP-1 were good biomarkers in predicting AKI; however, sCr remained the best biomarker. FEK (Fractional Excretion of potassium) emerged as another diagnostic tool to predict early AKI. Positive correlations between uNGAL and uMCP-1 with proteinuria and FENa may signal glomerular and tubular injury. Defects in urinary concentrations highlighted asymptomatic abnormalities, which deserve further study.
Highlights
Activated Partial Thromboplastin Time in the Acute kidney injury (AKI) group on admission revealed a higher number of patients with (6/22, (AKI)27% vsis. a4/41, 9.8%)complication and incoagulable bloodenvenomation tests (14/22, Snakebite-related acuteabnormal kidney injury common following vs 20/41, 48.7%) (p = 0.03).aPTT in the AKI group, including abnormal and incoagulable blood by snakes of the genus Bothrops, of which incidence varies between 1.4 and 38.5% [1,2,3,4,5]
The most common coagulation syndromes related to snake envenomation are venom-induced and disclosed lower serum sodium (p = 0.01, OR = 0.73, 95% CI: 0.57–0.94) and aPTT levels (p = 0.031, consumption coagulopathy (VICC), thrombotic microangiopathy (TMA)
Lower hemoglobin levels in the AKI group suggest a contribution of the hemotoxic mechanism following Bothrops venom-related AKI
Summary
Activated Partial Thromboplastin Time (aPTT) in the AKI group on admission revealed a higher number of patients with (6/22, (AKI). APTT in the AKI group, including abnormal and incoagulable blood by snakes of the genus Bothrops, of which incidence varies between 1.4 and 38.5% [1,2,3,4,5]. That are medically important: B. jararaca (South and Southeast), B. moojeni (Center-West), B. atrox group showed higher levels urinary. Renal tubular injury may be similar in both groups (Figure 2). The most common coagulation syndromes related to snake envenomation are venom-induced and disclosed lower serum sodium (p = 0.01, OR = 0.73, 95% CI: 0.57–0.94) and aPTT levels (p = 0.031, consumption coagulopathy (VICC), thrombotic microangiopathy (TMA). Receiver operating curves were constructed to disturbances, novel biomarkers renal (Figure tubular). Display true positive and false positive rates of AKI on admission. sCr showed better performance
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
