Clinical and Laboratory Parameters Associated with Acute Kidney Injury in Viper Envenomed Cases

Viper species are distributed allover Egypt. Venomous bites by Viperidae snakes are associated with local and systemic manifestations and may be exacerbated by the development of acute kidney injury (AKI).
THE AIM of the study was to assess acute renal injury in cases of envenomations by locally prevalent vipers as regards incidence, clinical and laboratory parameters and final outcome. 
METHODS: The current study was conducted on all patients, of both sex, admitted in Poison Control Center of Ain Shams University hospitals following envenomation by Viperidae snakes during 2014, 2015, and 2016. Diagnosis was based on history of snake bite with suggestive clinical data. Recorded data included patient characteristics (age, gender, delay time), vital data (heart rate, blood pressure), presence of local signs, bleeding manifestations, laboratory parameters (INR, platelet count, hemoglobin level, BUN and serum creatinine), number of antivenom vials used , duration of hospital stay and survival. Cases were sub-grouped to group I with AKI and group II without AKI.
RESULTS: A total of 120 cases of venomous bites by Viperidae snakes were recorded during the study period with mortality of 4.2%. Cases were predominantly males with mean age of 35 +/-14.7years. A subset of 5.8% cases developed AKI which statistically was related to older age, longer delay time, increased incidence of bleeding manifestations and tachycardia, higher values of INR, serum creatinine, and blood urea nitrogen, lower platelet count, higher number of used antivenom vials and longer duration of hospital stay. Gender, hypotension, presence of local manifestations and hemoglobin level were insignificant among AKI. Mortality among AKI cases was statistically linked to old age, prolonged delay time, increased incidence of bleeding manifestations, higher INR values, low platelet count and low hemoglobin level and increased number of used antivenom vials and duration of hospital stay. The incidence of tachycardia, hypotension and local manifestations, serum creatinine and blood urea nitrogen levels were not statistically different among non- survivors.
CONCLUSION: Acute renal injury may complicate the course of viper envenomations. Venom hemotoxicity is related to morbidity and mortality especially with older age and longer time between bite to antivenom therapy.