Severe acute kidney injury following Sri Lankan Hypnale spp. envenoming is associated with thrombotic microangiopathy.

Autor: Wijewickrama ES; Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Gooneratne LV; Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Gnanathasan A; Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Gawarammana I; Department of Medicine and South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka., Gunatilake M; Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka., Isbister GK; Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia.; South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
Jazyk: angličtina
Zdroj: Clinical toxicology (Philadelphia, Pa.) [Clin Toxicol (Phila)] 2021 Apr; Vol. 59 (4), pp. 296-302. Date of Electronic Publication: 2020 Sep 01.
DOI: 10.1080/15563650.2020.1810695
Abstrakt: Context: Acute kidney injury (AKI) is the most serious clinical manifestation of the Sri Lankan hump-nosed pit viper ( Hypnale spp.) bites. Thrombotic microangiopathy (TMA) is increasingly recognized in association with AKI in cases of Hypnale spp envenomation. We investigated AKI in a cohort of cases of Hypnale envenomation, its association with TMA and the early diagnostic value of common biomarkers for AKI occurring.
Materials and Methods: We conducted a prospective observational study of suspected viper bites and included 103 confirmed cases of Hypnale envenomation, based on venom specific enzyme immunoassay of blood. AKI was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Thrombotic microangiopathy was diagnosed based on thrombocytopenia (platelet count < 150,000 × 10 3 /μL) and microangiopathic haemolytic anaemia (MAHA). We investigated the diagnostic performance of creatinine, platelet count and INR for AKI within 4 h and 8 h post-bite by area under the receiver operator characteristic curve (AUC-ROC).
Results: Ten patients developed AKI: seven AKI stage 1 and three AKI stage 3. Ten patients (10%) developed thrombocytopaenia while 11 (11%) had MAHA. All three AKI stage 3 had thrombocytopaenia and MAHA fulfilling the criteria for TMA. Two of them presented with oliguria/anuria and all three required haemodialysis. Serum creatinine within 4 h post-bite was the best predictor of AKI with AUC-ROC of 0.83 (95% CI: 0.67-0.99) and was no better within 8 h of the bite.
Conclusions: We found that AKI is uncommon in Hypnale spp. envenomation, but an important serious complication. Severe AKI was associated with TMA. A creatinine within 4 h post-bite was the best predictor of AKI.
Databáze: MEDLINE
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