Abstract
Bothrops are one of the most common medically important snakes found in Latin America. Its venom is predominantly hemotoxic and proteolytic, which means that local lesion (edema and redness) and hemorrhagic symptoms are recurrent in envenoming by this snake. Although hemorrhage is usually the major cause of death, snakebite-related acute kidney injury is another potentially fatal clinical complication that may lead to chronic kidney disease. The present review highlights the main studies on Bothrops venom-related acute kidney injury, including observational, cross-sectional, case-control and cohort human studies available up to December 2019. The following descriptors were used according to Medical Subject Headings (MeSH): on Medline/Pubmed and Google Scholar “acute kidney injury” or “kidney disease” and “Bothrops”; on Lilacs and SciELO “kidney disease” or “acute kidney injury” and “Bothrops”. Newcastle-Ottawa quality assessment scale was used to appraise the quality of the cross-sectional and cohort studies included. The selection of more severe patients who looked for health care units and tertiary centers is a risk of bias. Due to the methodological heterogeneity of the studies, a critical analysis of the results was performed based on the hypothesis that the design of the included studies influences the incidence of acute kidney injury. Fifteen human studies (total participants 4624) were included according to stablished criteria. The coagulation abnormalities (hemorrhagic symptoms, abnormal fibrinogen and activated partial thromboplastin time) were associated with acute kidney injury in the most recent studies reported. The findings observed in this review provide up-to-date evidence about the acute kidney injury pathogenesis following Bothrops syndrome. Studies pointed out that coagulation abnormalities comprise the major pathway for acute kidney injury development. This review may improve patient management by primary healthcare providers, allowing earlier diagnosis and treatment of Bothrops venom-related acute kidney injury.
Highlights
Snakebite envenoming was considered again a neglected tropical disease by World Health Organization (WHO) in 2017 [1]
The findings observed in this review provide up-todate evidence about the acute kidney injury pathogenesis following Bothrops syndrome
Hrovat et al [102] carried out a prospective study about renal dysfunction in dogs envenomed by cytotoxic (n = 11) and neurotoxic snakebites (n = 8), evidencing 80% of hematuria 24 hours after envenomation
Summary
Snakebite envenoming was considered again a neglected tropical disease by World Health Organization (WHO) in 2017 [1]. The incidence of AKI in developing countries varies between 0.7% to 31.0% and there is great heterogeneity in different areas [3]. In this context, AKI is reported in young persons caused by a single clinical condition, such as infectious diseases and envenoming [3, 4]. In Latin America, most snakebites are caused by Bothrops snakes and lead to hemotoxic envenoming. Snakebite-related acute kidney injury (AKI) is a common severe complication of this envenoming that may cause death [5–7]. Hemotoxic snake venoms can provoke kidney abnormalities that contribute to chronic kidney diseases in developing countries [12, 13]. This review focuses on the pathogenesis of Bothrops venom-related AKI, highlighting current studies under a perspective of clinical application. Direct action of venom on kidney and its hemodynamic effects, myoglobinuria, hemoglobinuria and immunologic mechanisms may play a minor role as reported in experimental studies [15–21]
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
