- Title
- Severe acute kidney injury following Sri Lankan Hypnale spp. envenoming is associated with thrombotic microangiopathy
- Creator
- Wijewickrama, Eranga S.; Gooneratne, Lalindra V.; Gnanathasan, Ariaranee; Gawarammana, Indika; Gunatilake, Mangala; Isbister, Geoffrey K.
- Relation
- NHMRC.ID1110343 http://purl.org/au-research/grants/nhmrc/1110343 & ID1061041 http://purl.org/au-research/grants/nhmrc/1061041
- Relation
- Clinical Toxicology Vol. 59, Issue 4, p. 296-302
- Publisher Link
- http://dx.doi.org/10.1080/15563650.2020.1810695
- Publisher
- Taylor & Francis
- Resource Type
- journal article
- Date
- 2021
- Description
- Context: Acute kidney injury (AKI) is the most serious clinical manifestation of the Sri Lankan hump-nosed pit viper (Hypnale spp.) bites. Thrombotic microangiopathy (TMA) is increasingly recognized in association with AKI in cases of Hypnale spp envenomation. We investigated AKI in a cohort of cases of Hypnale envenomation, 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 of Hypnale envenomation, 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 103/μL) 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 in Hypnale spp. 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.
- Subject
- hump-nosed pit viper; Hypnale species; acute kidney injury; thrombotic microangiopathy; Sri Lanka; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1461677
- Identifier
- uon:46271
- Identifier
- ISSN:1556-3650
- Language
- eng
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