MON-202 EVALUATION OF SURROGATE PREDICTORS OF MORTALITY DUE TO SNAKE ENVENOMATION AND RENAL HISTOPATHOLOGICAL CORRELATION

Abstract

To evaluate the surrogate predictors of mortality due to venomous snake bite and to study the spectrum of histopathological changes of kidney in death due to venomous snake bite. One year Descriptive, Observational, Cross-sectional, Hospital and Mortuary based study. During autopsy, detailed external and internal examination was done to find the macroscopic changes at the local area of bite, kidneys. The slices of tissue from Kidneys were taken from selected cases in such a way that a slice contains all the physiological layers of the organ including diseased and normal (as seen on naked eye examination) portions with intervening transitional zone. Stained slides were examined under microscope to identify any pathological changes in kidney tissues. The findings of histopathological study were compared with that of the normal tissues. Thus the pathological process as identified in respect to the tissue involved. Macroscopic features on autopsy shows 4.1% with only congestion, congested with focal medullary haemorrhage in 36.7%, congested with patchy corticomedullary haemorrhage in 8.2%, congested with diffuse haemorrhage in 51.02%. Renal histopathological findings shows the predominant feature is Tubular Necrosis found in 57.1% of cases. 8.2% of cases shows Cortical Necrosis. Thrombi in blood vessels were found in 14.3% of cases. Of the Tubular Necrosis cases 20.4% of cases presented with dilated tubules lined by flattened epithelium & tubules shows hyalinised material in its lumen; 8.2% of cases shows small tubules containing proteinetious material in their lumen. All the cases shows features of congestion and inflammation. Haemorrhage is seen in 95.9% of cases. The predominant feature is Tubular Necrosis found in 57.1% of cases. 8.2% of cases shows Cortical Necrosis. Thrombi in blood vessels were found in 14.3% of cases. Of the Tubular Necrosis cases 20.4% of cases presented with dilated tubules lined by flattened epithelium & tubules shows hyalinised material in its lumen; 8.2% of cases shows small tubules containing proteinetious material in their lumen. All the cases shows features of congestion and inflammation. Haemorrhage is seen in 95.9% of cases. Multivariate analysis shows only number of AVS (0.020), duration of hospital stay/period of survivability (0.024), bleeding manifestations (0.000), shock/hypotension (0.000) & DIC (0.000) are positively correlated with Tubular Necrosis. With Cortical Necrosis, there is correlation with DIC (0.026) only. Whereas, only shock/hypotension (0.013) gives positive correlation with the presence of thrombi in blood vessels The prognosis for snakebite depends on factors besides hospital treatment: whether first aid is given immediately after the bite, early initiation of appropriate treatment, and the type of snake involved along with amount and severity of venom. Histopathological changes, especially in renal tissue can aid in differentiating between the nature of snake and the damage it causes.