期刊
CLINICAL TOXICOLOGY
卷 59, 期 4, 页码 296-302出版社
TAYLOR & FRANCIS LTD
DOI: 10.1080/15563650.2020.1810695
关键词
Hump-nosed pit viper; Hypnalespecies; acute kidney injury; thrombotic microangiopathy; Sri Lanka
类别
资金
- Australian National Health and Medical Research Council (NHMRC) Centre for Research Excellence [ID1110343]
- NHMRC Senior Research Fellowship [ID1061041]
In cases of Sri Lankan hump-nosed pit viper (Hypnalespp.) bites, AKI is a serious complication associated with TMA. Serum creatinine within 4 hours post-bite is the best predictor for AKI.
Context Acute kidney injury (AKI) is the most serious clinical manifestation of the Sri Lankan hump-nosed pit viper (Hypnalespp.) bites. Thrombotic microangiopathy (TMA) is increasingly recognized in association with AKI in cases ofHypnalespp envenomation. We investigated AKI in a cohort of cases ofHypnaleenvenomation, 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 ofHypnaleenvenomation, 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 x 10(3)/mu L) 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 inHypnalespp. 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.
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