A forward to optimization of antivenom therapy: An in vivo study upon the effectiveness of the antivenom against early and delayed nephrotoxicity induced by the venom of the Iranian scorpion Hemiscorpius lepturus in rat.

The aim of the present in vivo study was to identify the optimal effective dose, the most favorable time and the route of administration of the available polyvalent scorpion antivenom against the toxic effects induced by Hemiscorpius lepturus (H. lepturus) venom in rat. The end point for assessment included measurement of alanin-amino-peptidase (AAP) and N-acetyl-b-d-glucosaminidase (NAG), biochemical urine analysis and histopathological assessment. The results showed that a single subcutaneous 50 µg of the venom produced significant increase in the AAP and NAG enzyme activity, urinary biochemical parameters and induced histopathological structural abnormalities in the renal system. The optimal effective co-administered dose of the antivenom was 0.5 ml, which when administered 1 and 2 h of envenomation by intravenous (IV) and subcutaneous (SC) routes respectively produced significant protection against these toxic effects. Prudently, the significance of these findings need to be assessed in further clinical studies.

Renal function in transfusion-dependent pediatric beta-thalassemia major patients.

PURPOSE: In this study, the relationship between glomerular and tubular function and creatinine, glomerular filtration rate (GFR) and urine NAG in thalassemia major patients aged 7-16 years was investigated. DESIGN AND SETTING: This is a case-control study comprising 280 individuals [144 (51·4%), males; 136 (48·6%), females]. MATERIALS AND METHODS: Patients were divided in groups of 14 individuals and age groups of 7-16 years. Sodium excretion fraction, fraction excretion of potassium, calcium-to-creatinine and uric acid-to-creatinine ratios, and duration of specific blood transfusion were determined in all age groups receiving deferoxamine. RESULTS: GFR decreased with increasing age, but the correlation was not statistically significant. There was no significant correlation between the ferritin levels and the GFR changes. The mean value of NAG activity between thalassemic patients and controls has no significant difference. The difference in mean age of the groups with high NAG activity and normal NAG activity was statistically significant. Thirty-seven patients (52·1%) in the group with normal NAG activity, and 45 patients (6·25%) in the group with NAG activity above normal were observed with uricosuric effects with no significant difference. Four patients (6·9%) in the group with normal NAG activity and six patients (7·3%) in the group with NAG activity above normal were shown to have hematuria with no significant difference. The results show that the increase in serum ferritin is significantly correlated with the increase in NAG activity (P<0·001, r = 0·2). Of patients with normal NAG activity 1 (1·7%) and with NAG activity higher than normal, 13 (15·9%) cases experienced hypercalciuria that significant difference was existing. The data also indicated that the NAG changes do not correlate with GFR changes. CONCLUSION: The results showed that kidney dysfunction in thalassemia increases with increasing age, duration, and levels of blood transfusion and hypercalciuria. It is therefore recommended that the presence of severe renal dysfunction in thalassemic patients should be investigated using sensitive and specific tests, mainly NAG, to prevent progress towards the complications.