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Chronic kidney disease in snake envenomed patients with acute kidney injury in Sri Lanka: a descriptive study
  1. H M N J Herath1,
  2. A W M Wazil1,
  3. D T D J Abeysekara1,
  4. N D C Jeewani1,
  5. K G A D Weerakoon2,
  6. N V I Ratnatunga3,
  7. E H C K Bandara1,
  8. S A M Kularatne2
  1. 1Nephrology and Transplant Unit, Teaching Hospital, Kandy, Sri Lanka
  2. 2Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
  3. 3Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
  1. Correspondence to Professor S A M Kularatne, Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; samkul{at}sltnet.lk

Abstract

Background Data on the long-term outcomes of acute kidney injury (AKI) in envenomed patients leading to chronic kidney disease (CKD) are scarce. The aim of the study was to investigate this issue and to determine the predictive factors in developing CKD.

Methods The records of a series of 54 patients who had AKI following a snakebite during the period 2004–2009 and who had been followed up were reviewed in the nephrology unit, Kandy, Sri Lanka. The primary outcome measure was the failure of renal functions to return to normal within 1 year. The renal histology was studied in seven patients.

Results The mean age of the group was 50 years (SD 13 years) and 39 (72%) patients were men. The offending snakes were Russell's viper and hump-nosed viper in 15 (28%) and 13 (24%) patients, respectively. At 1 year, 20 patients (37%) had developed CKD (CKD group) and the rest (63%) had recovered (recovered group). The acute stage serum creatinine was high in both groups with no difference (on admission, p=0.134; on discharge, p=0.323), but the CKD group showed significantly high serum creatinine at 2 months after AKI (p=0.004). Mean duration of renal replacement therapy (RRT) of the recovered group and CKD group were 7 (SD 5) and 16 (SD 12) days, respectively (p=0.015). Renal histology of six CKD patients showed predominant glomerular sclerosis and interstitial nephritis.

Conclusions CKD is an outcome of severe AKI following snake envenoming probably predicted by the length of RRT.

  • Snakebite
  • envenoming
  • acute kidney injury
  • chronic kidney disease
  • Sri Lanka
  • asthma
  • accident and emergency medicine
  • tropical medicine
  • toxicology
  • epidemiology

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethical approval for the study was obtained from the Ethics Committee of the Faculty of Medicine, Peradeniya University, Sri Lanka.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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