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Snakebites are a prevalent health concern in various regions, often resulting in a wide range of clinical manifestations, including spontaneous bleeding. However, the specific mechanisms and factors influencing renal damage in snakebite patients remain inadequately understood. This study aims to investigate the renal biomarker profile in snakebite patients, with a particular focus on those with and without spontaneous bleeding, in order to gain a deeper understanding of the renal consequences of snake envenomation and the potential impact of antivenom therapy.
This is an observational, prospective study, consisting of 34 hospitalized patients with confirmed snakebite due to Bothrops erythromelas admitted to a referral hospital for victims of toxicological snakebites in the state of Ceará, Brazil, Instituto Dr. José Frota (IJF), from August 2021 to December 2022. Groups according spontaneous Bleeding on admission were constructed. AKI was determined using KDIGO criteria. Medical records were evaluated for clinical parameters. Blood and urine samples were collected at 3 different post-bite points in time: on admission (up to 8 h post-bite), after antivenom use, and from the 48 hours after antivenom use. Urinary NGAL, proteinuria, albuminuria, endothelial biomarkers (Angiopoietin-1, Angiopoietin-2, Syndecan-1) and von Willebrand Factor A2 domain (vWF-A2) were measured.
In total, 17 patients (50%) arrived with spontaneous bleeding on admission. Most laboratory parameters, including electrolytes, hematological parameters, and coagulation tests, showed no significant variations between the two groups. However, a notable difference was detected in proteinuria levels, with the group that presented with bleeding having significantly higher proteinuria levels. Conversely, no significant differences were noted in creatinine and urea levels, glomerular filtration rate, or albuminuria. The incidence of acute kidney injury (AKI) was found to be similar in both groups. In bleeding group, uNGAL levels remains higher even after receiving antivenom treatment. Additionally, there was an increase in angiopoietin-1 levels following antivenom use and a significant decrease in vWF-A2 levels, suggesting a complex interplay between these biomarkers.
Bothrops envenenomation caused important tubular kidney injury that remains installed even after antivenom use in the context of severe coagulation disturbances.