Kidney injury following envenoming by hump-nosed pit viper (Genus: Hypnale) in Sri Lanka: proven and probable cases

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene 2019-03, Vol.113 (3), p.131-142
• Main Authors: Rathnayaka, R M M K Namal, Ranathunga, P E A Nishanthi, Kularatne, S A M
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - etiology; Adult; Aged; Aged, 80 and over; Animals; Crotalid Venoms - toxicity; Crotalinae; Female; Hematuria - etiology; Humans; Male; Middle Aged; Oliguria - etiology; Prospective Studies; Proteinuria - etiology; Renal Insufficiency, Chronic - etiology; Snake Bites - complications; Snake Bites - pathology; Sri Lanka; Thrombotic Microangiopathies - etiology
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1093/trstmh/try120

Abstract Background Hump-nosed pit vipers (Hypnale hypnale) are highly venomous snakes found in Sri Lanka and the Western Ghats region of India. They are the most common cause of venomous snakebites in Sri Lanka, mainly causing local envenoming leading to pain, swelling and necrosis. Systemic envenoming causing acute kidney injury and coagulopathy are more commonly recognized following their bites. Method A series of 465 patients with hump-nosed viper bites was prospectively studied over four years from January 2014. All patients were assessed and the data were collected by the principal investigator (primary data). Results Forty-four (9.5%) patients developed acute kidney injury, of which 23 (5%) were proven cases and 21 (4.5%) were probable cases. Of the proven cases, 4 (17%) progressed to chronic kidney disease and 12 (52%) had thrombotic microangiopathy, from which 11 (48%) developed haemolytic uremic syndrome and 1 (4%) had thrombotic thrombocytopenic purpura. Twelve (52%) showed microangiopathic haemolysis and 15 (65%) had thrombocytopenia. Oliguria was observed in 10 (43%) whereas 7 (30%) each had anuria and normal urine output. Ten patients (43%) developed haematuria, from which 6 had microscopic haematuria and 4 had macroscopic haematuria. Proteinuria was observed in 8 (35%). Coagulopathy developed in 3 (13%) patients. In probable cases, 3 (14%) died due to complications of kidney injury. Conclusion A significant proportion of patients develop acute kidney injury following hump-nosed pit viper bite. Who will develop acute kidney injury or succumb to the venom is unpredictable. Reliable and accessible treatments are a critical unmet need.