Abstract
Snakebite-induced acute kidney injury (AKI) is frequently observed in patients following bites from vipers such as Russell’s viper (Daboia russelii) in India. Currently, the levels of serum creatinine are mainly used as a marker to determine the necessity for renal replacement therapy (RRT) (haemodialysis) in severe cases of AKI. However, it takes up to 48 h to ascertain a distinct change in creatinine levels compared to its baseline level upon admission. The time lost between admission and the 48 h timepoint significantly affects the clinical management of snakebite victims. Moreover, early diagnosis of AKI and decision on the necessity for RRT in snakebite victims is critical in saving lives, reducing long-term complications, and minimising treatment costs arising from expensive haemodialysis. Neutrophil gelatinase–associated lipocalin (NGAL) has been recently studied as a robust early marker for AKI in non-snakebite patients. However, its suitability for clinical use in snakebite victims has not been rigorously established. Here, we demonstrate the clinical significance of plasma NGAL as a robust marker for RRT following AKI using a large cohort (309) of Russell’s viper victims without any pre-existing health conditions. NGAL levels upon admission are positively correlated with creatinine levels at 48 h in different stages of AKI. Overall, NGAL acts as a robust early marker to ascertain the need for RRT following Russell’s viper bites. The quantification of NGAL can be recommended as a routine test in hospitals that treat snakebites to decide on RRT at early time points instead of waiting for 48 h to confirm the increase in creatinine levels. The diagnostic use of NGAL in Russell’s viper victims with pre-existing comorbidities and for other vipers should be evaluated in future studies.
Highlights
Snakebite envenomation (SBE) is a high priority, neglected tropical disease that predominantly affects rural communities living in developing countries such as India [1,2]
Following our exclusion and inclusion criteria, totally, 309 patients were recruited in this study, and they included 227 (73.5%) males and 82 (26.5%) females. They were further assigned into appropriate grades [by following the criteria provided by the acute kidney injury network (AKIN)] based on their serum creatinine levels or its fold increase at 48 h from baseline level creatinine at admission: grade 0 (101 patients)—74 (73.3%) males and 27 (26.7%) females; grade 1 (93)—72 (77.4%) males and 21 (22.6%) females; grade 2 (73)—49 (67.1%) males and 24 (32.9%) females; grade 3 (35)—26 (74.3%) males and 9 (25.7%) females; grade X (7)—6 (85.7%) males and 1 (14.3%) Toxins 2021, 13, x FOR PEER REVIEfWemale (Figure 1A)
These suggest that the severity of bite and elevation of creatinine levels were likely to be due to other factors such as the amount of venom injected in these patients
Summary
Snakebite envenomation (SBE) is a high priority, neglected tropical disease that predominantly affects rural communities living in developing countries such as India [1,2]. The levels of serum creatinine, blood urea nitrogen, urinary albumin/proteins, and urine outputs are considered as biomarkers to determine the functional status of kidneys and severity of AKI [14] These conventional markers are not ideal to establish the injuries arising from haemodynamic changes in kidneys that lead to variations in glomerular filtration rate, during acute damage [14,15]. We have conducted a rigorous clinical study with a large cohort of Russell’s viper bite victims and vigorous exclusion and inclusion criteria and demonstrate the significance of plasma NGAL as a robust early biomarker for AKI to determine the need for RRT in these patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
