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Animal toxins and the kidney

Nature Clinical Practice Nephrology volume 4, pages 616–627 (2008)Cite this article

Abstract

Envenomation or poisoning by toxins from animals poses an important health hazard in the tropics. Animal toxins are complex mixtures of proteins, peptides, enzymes and chemicals. These toxins exert their effects through modulation of ion channels and receptors, and via direct enzyme action. Depolarization or hyperpolarization of ion channels—caused by most marine toxins, and some snake and insect venoms—results in neuromuscular symptoms that can be associated with hemodynamic changes. Toxin enzymes, especially proteases and phospholipase A2, initiate inflammatory processes that involve the generation of proinflammatory cytokines and vasoactive mediators, resulting in systemic and renal hemodynamic alterations. Toxin enzymes also have direct effects on erythrocytes, myocytes, blood coagulation factors, vascular endothelium and epithelial cells. As a result, disseminated intravascular coagulation, bleeding diathesis, intravascular hemolysis and rhabdomyolysis are common after exposure to animal toxins. The renal manifestations of animal toxin envenomation, which are usually acute, result mainly from these enzymatic effects. All renal structures can be affected by animal toxins, and tubular necrosis is common. Acute kidney injury is attributed to decreased renal blood flow (associated with intravascular hemolysis or rhabdomyolysis), disseminated intravascular coagulation or direct tubular toxicity. Immunologic mechanisms have a minor role in the pathophysiology of nephropathy caused by animal toxins.

Key Points

  • Animal toxins are mixtures of enzymes, proteins, peptides and chemicals

  • Some toxin proteins have effects on ion channels that cause neuromuscular symptoms through modulation of cytosolic calcium levels and release of neurotransmitters

  • Toxin enzymes, such as phospholipase A2 and proteases, cause membrane lysis, pore formation, destruction of the cytoskeleton, disturbance of blood coagulation and release of proinflammatory cytokines and vasoactive mediators

  • The hemodynamic changes induced by proinflammatory cytokines and vasoactive mediators are characterized by decreased systemic vascular resistance, increased renal vascular resistance and decreased renal blood flow

  • The renal pathological changes that follow animal toxin exposure include tubular necrosis, cortical necrosis, vasculitis, glomerulonephritis, interstitial nephritis and infarction

  • Acute kidney injury, commonly caused by tubular necrosis, results from the combined effects of decreased renal blood flow, intravascular hemolysis, rhabdomyolysis, disseminated intravascular coagulation and direct nephrotoxicity

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Figure 1: Mechanisms of kidney damage caused by animal toxins.

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  1. Queen Saovabha Memorial Institute, 1871 Rama 4 Road, Bangkok 10330, Thailand visithstprj@yahoo.com

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  1. V Sitprija is Emeritus Professor of Medicine in the Faculty of Medicine at Chulalongkorn University and Director of the Queen Saovabha Memorial Institute, Bangkok, Thailand.,

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Sitprija, V. Animal toxins and the kidney. Nat Rev Nephrol 4, 616–627 (2008). https://doi.org/10.1038/ncpneph0941

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