Incidence of acute kidney injury and its associated factors among snake bite patients in rural area of Salem district

Dr. Suresh Kanna Singaram; Dr. Elanchezhian JA; Dr. Balamurugan Subbiah; Dr. Shankar Radhakrishnan

Incidence of acute kidney injury and its associated factors among snake bite patients in rural area of Salem district

Authors
Dr. Suresh Kanna Singaram, Dr. Elanchezhian JA, Dr. Balamurugan Subbiah, Dr. Shankar Radhakrishnan

Abstract
Background: In India Agriculture being one of the major occupations, snake bite is a familiar occupational hazard of farmers, plantation workers and others, resulting in tens of thousands of deaths each year and innumerable cases of chronic physical handi¬cap. India accounts for about 40 to 50,000 deaths per year due to snake bite. Among the four species Russell’s viper is the major cause of snakebite cases in India leading to increased morbidity and mortality mainly due to acute kidney injury (AKI).An incidence of renal involvement with snakebite envenomation was reported between 1.4–28% in various series of studies.

Aim: To assess the incidence and factors associated with development of acute kidney injury among the snake bite patients.

Methodology: A prospective study was conducted at Government Mohan Kumaramangalam Medical College,Salem for a period of one year between April 2015 and March 2016. A total of 131 snake bite patients were included in the study based on fulfilling the inclusion criteria. A detailed history taking related to type of snake and time of bite including the presenting symptoms were enquired and recorded and a complete physical examination was conducted in each case and laboratory investigations related to kidney and liver functions along with bleeding disorders was done for all patients. All the pa¬tients were followed either till discharge or death. The kidney injury was graded according to AKIN classification.

Results: The incidence of acute kidney injury among the snake bite patients was 32.3% with varying stage ranging from 1 to 3 among them stage 1 was found to be more common(16%) and stage 3 was reported in 3.8% of the patients. Cellulitis feature was found to be more common among the patients who had developed AKI and the incidence of cellulitis increases as the staging of AKI increases. Similarly ptosis, regional lymphadenopathy, respiratory failure, septicaemia and DIC increases as the severity of AKI increases. The increase in age, increase in the ASV vials used and longer duration between the bite and needle time were found to have a significant association with increase in the severity of AKI. Among 131 patients 21 patients required dialysis either in the form of hemodialysis or peritoneal dialysis and 18 patients died and among them 13 had AKI and in that 4 of them had stage 3 AKI.

Conclusion: Snake envenomation leading to acute kidney injury is a major health issue due to delayed referral to appropriate care centre. Early referral to specified care centre and prompt administration of ASV can reduce mortality and morbidity due to snake bite leading on to AKI.

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