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Snake envenomation-induced acute kidney injury: prognosis and long-term renal outcomes
  1. Manoj Kumar1,
  2. Maasila Arcot Thanjan2,
  3. Natarajan Gopalakrishnan1,
  4. Dhanapriya Jeyachandran1,
  5. Dineshkumar Thanigachalam1,
  6. Sakthirajan Ramanathan1
  1. 1 Institute of Nephrology, Madras Medical College, Chennai, Tamil Nadu, India
  2. 2 Nephrology, Government Vellore Medical College and Hospital, Vellore, Tamil Nadu, India
  1. Correspondence to Dr Manoj Kumar, Institute of Nephrology, Madras Medical College, Chennai 600003, India; manoj.k.king{at}


Background Snake bite continues to be a significant cause of acute kidney injury (AKI) in India. There is paucity of data regarding long-term outcomes of such patients. In this study, we aim to assess the prognosis and long-term renal outcomes of such patients.

Methods We analysed the hospital records of snake envenomation-induced AKI from January 2015 to December 2018. Predictors of in-hospital mortality were assessed. Survivors were advised to visit follow-up clinic to assess their kidney function.

Results There were 769 patients with evidence of envenomation and of them, 159 (20.7%) had AKI. There were 112 (70.4%) males. Mortality occurred in 9.4% of patients. Logistic regression analysis identified shock (OR 51.949, 95% CI 4.297 to 628.072) and thrombocytopenia (OR 27.248, 95% CI 3.276 to 226.609) as predictors of mortality. Forty-three patients attended the follow-up. The mean follow-up duration was 30.4±15.23 months. Adverse renal outcomes (eGFR <60 mL/min/1.73 m2 or new-onset hypertension (HTN) or pre-HTN or urine protein creatinine ratio >0.3) occurred in 48.8% of patients. Older age (mean age (years) 53.3 vs 42.8, p=0.004) and longer duration on dialysis (median duration (days) 11.5 vs 5, p=0.024) were significantly associated with adverse renal outcomes.

Conclusions The incidence of AKI in snake envenomation was 20.7%. The presence of shock and thrombocytopenia were associated with mortality. Adverse renal outcomes occurred in 48.8% of patients in the long term.

  • acute renal failure
  • chronic renal failure
  • toxicology

Data availability statement

All data relevant to the study are included in the article.

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Data availability statement

All data relevant to the study are included in the article.

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  • Contributors MK and MAT designed the study, collected the data. MK did the statistical analysis and manuscript writing. NG conceptualised and designed the study, edited the manuscript and gave final approval for submission. All other authors contributed to study designing and manuscript editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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