Acute renal failure [ARF] following snake bite: a study of 35 cases

ABSTRACT

Objectives To study the prevalence, common presentation and factors causing mortality in snake bite induced ARF. Methods From January 1990 to December 1998, a total of 1716 cases of ARF were registered at SlUT [criteria of defining ARF was a rise in creatinine of> 2 mg% and normal size kidneys on ultrasound in a person without any previous systemic illness]. In 35 patients there was a history of snake bite preceeding ARF. Results of laboratory investigations and modalities of renal replacement therapy and outcome were analysed. Results Among 1716 cases of ARF, 764[43.4%] were due to medical causes, 485[28.2%] surgical, 298[17.3%] obstetrical and 169 [9.8%] due to miscellaneous and unknown causes. Thirty five patients, 22 males, 13 females, age range from 6- 65 years from the medical group, developed ARF after snake bite. The most common presentation was anuria and bleeding diathesis. Haemodialysis was started immediately after admission in 31 and peritoneal dialysis in 2 patients and two died before initiation of therapy. Twenty three [66%] patients recovered from renal failure in 2-3 weeks, 6 [17%] required long term dialysis [five of them had cortical necrosis], and 6 [17%] patients expired. Conclusion Bleeding diathesis induced by snake envenomation carries bad prognosis both in terms of mortality and morbidity with irreversible renal failure being the cause. Early initiation of dialysis therapy leads to rapid renal recovery