Chronic Kidney Disease after Snake Envenomation Induced Acute Kidney Injury

Abstract

Snake bite is an important cause for acute kidney injury (AKI) in the tropics and the victims are often otherwise healthy young adults without conventional risk factors for chronic kidney disease (CKD). Available literature on long-term outcomes of AKI –snake envenomation is limited, with only two small retrospective studies with follow-up periods of two years or less. In a hospital-based prospective and retrospective follow-up study, all consecutive adult patients who developed AKI and discharged alive were recruited in the prospective group and for retrospective analysis, we retrieved medical records of patients hospitalized with snake bite from the digitized medical records. Clinical and biochemical characteristics during hospitalization and on follow-up were collected. We recruited 193 patients with snake bite and AKI in a prospective (140) and a retrospective (53) group. Of the 193 AKI patients, 162 (84%) had estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 at the time of discharge from hospital and at follow-up (n = 171) 29 (16.9%) had eGFR<60 mL/min/1.73 m2. Of the 116 patients with follow-up beyond one year, 30 (26%) had CKD. Overall 26 to 28% of patients went on to develop CKD depending on the duration of follow-up. Only very few (1.16%) patients progressed to ESRD. This is the largest follow-up study so far on snake bite-related AKI and provides further evidence that snake bite-associated AKI causes CKD on long-term follow-up. Older age, diabetes, severe AKI, and inadequate anti-snake venom administration were risk factors for the development of CKD on follow-up.