Clinicopathological study of post russell's viper bite renal failure patients

ABSTRACT

Six patients returning due to various symptoms between 2 months to 11 months after recovering from acute renal failure following Russell's viper bite were investigated. Urine RE, C & S, Blood urea, electrolyte, creatinine, cholesterol, serum protein, were estimated. Ultrasound abdomen and renogram were performed. Renal biopsy was performed if suggestive of renal involvement. Autopsied tissue from four patients in the acute stage were included. Biopsy was taken from five patients with nocturia of 2-4 times. Three patients with proteinuria, (trace to ++). One patient with hypertension of 170/100 mm Hg discovered 8 months after recovery. The glomerular changes consisted of mild degrees of glomerular necrosis. Fluid collection and adhesion between the glomeruli and the Bowman's capsule were seen in all the cases but more marked in the ones who expired. Ballooning of the capillary loops with thickening of the basement membrane were seen only in three biopsied cases who presented with proteinuria and nocturia. Mild to moderate tubular degeneration was noted in all the cases. Interstitial fibrosis occurred in two of the biopsied cases presenting with nocturia. Thus changes in both the glomeruli and tubules and interstitium persist even after 11 months following Russell's bite and may manifest as nocturia, proteinuria and occasionally hypertension.