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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Nephrology 1/2017

Clinical and laboratory parameters associated with acute kidney injury in patients with snakebite envenomation: a prospective observational study from Myanmar

Zeitschrift:
BMC Nephrology > Ausgabe 1/2017
Autoren:
Kyi-Phyu Aye, Vipa Thanachartwet, Chit Soe, Varunee Desakorn, Khin-Thida Thwin, Supat Chamnanchanunt, Duangjai Sahassananda, Thanom Supaporn, Visith Sitprija
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12882-017-0510-0) contains supplementary material, which is available to authorized users.

Abstract

Background

Snakebite-related acute kidney injury (AKI) is a common community-acquired AKI in tropical countries leading to death and disability. The aims of this study were to (1) determine the occurrence of snakebite-related AKI, (2) assess factors at presentation that are associated with snakebite-related AKI, and (3) determine the outcomes of patients with snakebite-related AKI.

Methods

We conducted a prospective observational study of patients with snake envenomation at the three academic tertiary care hospitals in Yangon, Myanmar between March 2015 and June 2016. Patient data including baseline characteristics, clinical and laboratory findings, hospital management, and outcomes were recorded in a case report form. A stepwise multivariate logistic regression analysis using a backward selection method determined independent factors significantly associated with AKI.

Results

AKI was observed in 140 patients (54.3%), the majority of whom were AKI stage III (110 patients, 78.6%). AKI occurred at presentation and developed during hospitalization in 88 (62.9%) and 52 patients (37.1%), respectively. Twenty-seven patients died (19.3%), and 69 patients (49.3%) required dialysis. On multivariate logistic regression analysis, (1) snakebites from the Viperidae family (odds ratio [OR]: 9.65, 95% confidence interval [CI]: 2.42–38.44; p = 0.001), (2) WBC >10 × 103 cells/μL (OR: 3.55, 95% CI: 1.35–9.34; p = 0.010), (3) overt disseminated intravascular coagulation (OR: 2.23, 95% CI: 1.02–4.89; p = 0.045), (4) serum creatine kinase >500 IU/L (OR: 4.06, 95% CI: 1.71–9.63; p = 0.001), (5) serum sodium <135 mmol/L (OR: 4.37, 95% CI: 2.04–9.38; p < 0.001), (6) presence of microscopic hematuria (OR: 3.60, 95% CI: 1.45–8.91; p = 0.006), and (7) duration from snakebite to receiving antivenom ≥2 h (OR: 3.73, 95% CI: 1.48–9.37; p = 0.005) were independently associated with AKI. Patients bitten by Viperidae with normal renal function who had serum sodium <135 mmol/L had a significantly higher urine sodium-to-creatinine ratio than those with serum sodium ≥135 mmol/L (p < 0.001).

Conclusions

Identifying factors associated with snakebite-related AKI might help clinicians to be aware of snakebite patients who are at risk of AKI, particularly patients who demonstrate renal tubular dysfunction after Viperidae bites.
Zusatzmaterial
Additional file 1: Table S1. Definitions of abnormal urine findings and electrolyte abnormalities. Table S2. Definitions of clinical parameters of snake envenoming according to the WHO 2010 guidelines. Table S3. Baseline characteristics and pre-hospital management among 258 adults with snakebite envenomation, Yangon, Myanmar, 2015–2016. Table S4. Clinical presentation among 258 adults with snakebite envenomation, Yangon, Myanmar, 2015–2016. Table S5. Laboratory parameters at presentation among 258 adults with snakebite envenomation, Yangon, Myanmar, 2015–2016. Table S6. Management and outcomes among 258 adults with snakebite envenomation, Yangon, Myanmar, 2015–2016. Table S7. Clinical parameters among 164 adults bitten by Viperidae or presenting the clinical syndrome of Viperidae (86 patients with acute kidney injury at presentation and 78 patients without acute kidney injury). Table S8. Laboratory parameters among 164 adults bitten by Viperidae or presenting the clinical syndrome of Viperidae (86 patients with acute kidney injury at presentation and 78 patients without acute kidney injury). Table S9. Management and outcomes among 164 adults bitten by Viperidae or presenting the clinical syndrome of Viperidae (86 patients with acute kidney injury at presentation and 78 patients without acute kidney injury). Table S10. Clinical parameters among 128 adults bitten by Viperidae or presenting the clinical syndrome of Viperidae (50 patients who developed acute kidney injury during hospitalization and 78 patients without acute kidney injury). Table S11. Laboratory parameters among 128 adults bitten by Viperidae or presenting the clinical syndrome of Viperidae (50 patients who developed acute kidney injury during hospitalization and 78 patients without acute kidney injury). Table S12. Management and outcomes among 128 adults bitten by Viperidae or presenting the clinical syndrome of Viperidae (50 patients who developed acute kidney injury during hospitalization and 78 patients without acute kidney injury). The supplementary tables provide additional data to help interpret the results of the study. (DOCX 92 kb)
12882_2017_510_MOESM1_ESM.docx
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