Correlation of renal status with hematologic profile in viperine bite.

Abstract

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.