SNAKE BITE RELATED DIALYSIS REQUIRING ACUTE KIDNEY INJURY AND ITS OUTCOME ON ONE YEAR FOLLOW UP: A SINGLE CENTRE EXPERIENCE FROM SOUTH INDIA

Introduction:

Snake bite is more common in the tropical and subtropical countries where majority of population is involved in agriculture, making them more vulnerable. Snake bite related complications is a major cause of morbidity and mortality in the population, of which acute kidney injury (AKI) is much more significant. The causes for AKI due to snake bite includes sepsis, hemolysis, myonecrosis (compartment syndrome), drug related (use of indigenous drugs in rural areas), thrombotic microangiopathy (TMA) and others.

Environmental factors such as long rainy season, presence of abundant flora and fauna also increases the risk of snake bite. Lack of awareness and use of indigenous drugs makes people more prone for AKI and other related complications of snake bite.

Methods:

Study design- Retrospective cohort study

Study duration- 3 years

Study setting- A tertiary care centre based study

Study population- Among the 522 patients admitted with history of snake bite from January 2021 to January 2023,151 patients had acute kidney injury, of which 46 patients required hemodialysis support. Of the 46 patients, renal biopsy was done for 16 patients who did not recover after 3 weeks. These patients were followed up for a period of 1 year

Inclusion criteria – 1) history of snake bite

2) AKI as defined by KDIGO criteria

3) Patients requiring hemodialysis

Exclusion criteria- 1) Patients with chronic kidney disease

2) Patient refusal

Results:

All the data collected was analyzed using SPSS statistical software version 25

The mean age of the study population was 43.70 ± 14.96

Out of the 46 patients, 29 were male

The mean serum LDH (lactate dehydrogenase) for patients with hemoglobin cast was 2179.40 ± 787.23 IU/L

The mean serum CPK (creatine phosphokinase) for patients with myoglobin cast was 12000 ± 1500 IU/L

The mean number of hemodialysis sessions underwent by the patients who have recovered within 3 weeks (not undergone renal biopsy, N=30) is 4.3 ± 1.3 and those who have undergone renal biopsy is 8.5 ± 2.5 (N=12, excluding 4 patients on maintenance hemodialysis)

Out of the 46 patients, 4 of them expired, thus mortality accounting for 8.6 % (two patients with TMA, one with patchy cortical necrosis, one with sepsis-expired within a week of admission) and 3 patients were lost to follow up

One patient with patchy cortical necrosis is now on maintenance hemodialysis.

Conclusions:

From our study, thrombotic microangiopathy and cortical necrosis had grave prognosis. Patients with pigment nephropathy and tubulointerstitial nephritis had a comparatively better prognosis with stable renal functions not requiring maintenance hemodialysis. Snake bite related sepsis is also a major cause of mortality.

Being a single centre study, further long term follow up is necessary to identify the progression to chronic kidney disease in these patients.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.