Thrombotic microangiopathy: An under-recognised cause of snake-bite-related acute kidney injury

Indu Ramachandra Rao, Attur Ravindra Prabhu, Shankar Prasad Nagaraju, Dharshan Rangaswamy

Research output: Contribution to journalArticle

Abstract

Introduction: Thrombotic microangiopathy (TMA) as a cause of snake-bite-induced acute kidney injury (AKI) is rarely reported. Very little is known about the clinical course, optimal management, and prognosis of this entity. We describe a series of snake-bite-induced TMA and compare their outcomes with those without TMA. Methods: This was a single-center retrospective study of patients with AKI following snake envenomation admitted between January 2012 and December 2017. Demographic profile, clinical parameters, and outcomes were studied. TMA was diagnosed based on presence of triad of microangiopathic hemolytic anemia, thrombocytopenia, and AKI, and groups with and without TMA were compared. Results: Of 103 patients with AKI following snake bite, 19 (18.5%) had clinical evidence of TMA. All patients with TMA had advanced azotemia (mean peak serum creatinine 9.5 ± 3.0 mg/dL), with 18 (95%) requiring renal replacement therapy (RRT). Thirteen (68%) had either complete or partial recovery of renal functions, two (10%) progressed to end-stage renal disease, and one died (three patients were lost to follow-up). Age ≥50 years, presence of oliguria/anuria, anti-snake venom dose ≥10 vials, and urea ≥80 mg/dL at presentation were independently associated with TMA (P < 0.05). RRT requirement (95% vs. 57%), mean number of RRT sessions (18 vs. 4.5 sessions), and hospital stay ≥7 days (84% vs. 58%) were higher in patients with TMA (P < 0.05), but patient outcomes did not differ. Conclusions: In conclusion, TMA was seen in 18.5% of patients with snake-bite-related AKI in our study and was associated with almost universal need for RRT, longer duration on RRT, and hospital stay compared with patients without TMA.

Original languageEnglish
Pages (from-to)324-328
Number of pages5
JournalIndian Journal of Nephrology
Volume29
Issue number5
DOIs
Publication statusPublished - 01-09-2019

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Thrombotic Microangiopathies
Snake Bites
Acute Kidney Injury
Renal Replacement Therapy
Length of Stay
Antivenins
Azotemia
Oliguria
Anuria
Snake Venoms
Lost to Follow-Up
Hemolytic Anemia
Recovery of Function
Thrombocytopenia
Chronic Kidney Failure
Urea
Creatinine
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Rao, Indu Ramachandra ; Prabhu, Attur Ravindra ; Nagaraju, Shankar Prasad ; Rangaswamy, Dharshan. / Thrombotic microangiopathy : An under-recognised cause of snake-bite-related acute kidney injury. In: Indian Journal of Nephrology. 2019 ; Vol. 29, No. 5. pp. 324-328.
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abstract = "Introduction: Thrombotic microangiopathy (TMA) as a cause of snake-bite-induced acute kidney injury (AKI) is rarely reported. Very little is known about the clinical course, optimal management, and prognosis of this entity. We describe a series of snake-bite-induced TMA and compare their outcomes with those without TMA. Methods: This was a single-center retrospective study of patients with AKI following snake envenomation admitted between January 2012 and December 2017. Demographic profile, clinical parameters, and outcomes were studied. TMA was diagnosed based on presence of triad of microangiopathic hemolytic anemia, thrombocytopenia, and AKI, and groups with and without TMA were compared. Results: Of 103 patients with AKI following snake bite, 19 (18.5{\%}) had clinical evidence of TMA. All patients with TMA had advanced azotemia (mean peak serum creatinine 9.5 ± 3.0 mg/dL), with 18 (95{\%}) requiring renal replacement therapy (RRT). Thirteen (68{\%}) had either complete or partial recovery of renal functions, two (10{\%}) progressed to end-stage renal disease, and one died (three patients were lost to follow-up). Age ≥50 years, presence of oliguria/anuria, anti-snake venom dose ≥10 vials, and urea ≥80 mg/dL at presentation were independently associated with TMA (P < 0.05). RRT requirement (95{\%} vs. 57{\%}), mean number of RRT sessions (18 vs. 4.5 sessions), and hospital stay ≥7 days (84{\%} vs. 58{\%}) were higher in patients with TMA (P < 0.05), but patient outcomes did not differ. Conclusions: In conclusion, TMA was seen in 18.5{\%} of patients with snake-bite-related AKI in our study and was associated with almost universal need for RRT, longer duration on RRT, and hospital stay compared with patients without TMA.",
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Thrombotic microangiopathy : An under-recognised cause of snake-bite-related acute kidney injury. / Rao, Indu Ramachandra; Prabhu, Attur Ravindra; Nagaraju, Shankar Prasad; Rangaswamy, Dharshan.

In: Indian Journal of Nephrology, Vol. 29, No. 5, 01.09.2019, p. 324-328.

Research output: Contribution to journalArticle

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T2 - An under-recognised cause of snake-bite-related acute kidney injury

AU - Rao, Indu Ramachandra

AU - Prabhu, Attur Ravindra

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AU - Rangaswamy, Dharshan

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AB - Introduction: Thrombotic microangiopathy (TMA) as a cause of snake-bite-induced acute kidney injury (AKI) is rarely reported. Very little is known about the clinical course, optimal management, and prognosis of this entity. We describe a series of snake-bite-induced TMA and compare their outcomes with those without TMA. Methods: This was a single-center retrospective study of patients with AKI following snake envenomation admitted between January 2012 and December 2017. Demographic profile, clinical parameters, and outcomes were studied. TMA was diagnosed based on presence of triad of microangiopathic hemolytic anemia, thrombocytopenia, and AKI, and groups with and without TMA were compared. Results: Of 103 patients with AKI following snake bite, 19 (18.5%) had clinical evidence of TMA. All patients with TMA had advanced azotemia (mean peak serum creatinine 9.5 ± 3.0 mg/dL), with 18 (95%) requiring renal replacement therapy (RRT). Thirteen (68%) had either complete or partial recovery of renal functions, two (10%) progressed to end-stage renal disease, and one died (three patients were lost to follow-up). Age ≥50 years, presence of oliguria/anuria, anti-snake venom dose ≥10 vials, and urea ≥80 mg/dL at presentation were independently associated with TMA (P < 0.05). RRT requirement (95% vs. 57%), mean number of RRT sessions (18 vs. 4.5 sessions), and hospital stay ≥7 days (84% vs. 58%) were higher in patients with TMA (P < 0.05), but patient outcomes did not differ. Conclusions: In conclusion, TMA was seen in 18.5% of patients with snake-bite-related AKI in our study and was associated with almost universal need for RRT, longer duration on RRT, and hospital stay compared with patients without TMA.

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