Introduction: The ophidian accident is an intoxication caused by the inoculation of venom throughthe bite of a snake, which generates local and systemic alterations. This event represents an important public health problem in developing countries due to its high frequency and severity. Snakes of the genus Bothrops are responsible for the majority of accidents, and this is partly due to their wide geographic distribution and aggressive behavior when threatened. Acute kidney injury is an importantcause of mortality in patients with snake bites of this genus.
Purpose: To describe the case of a female patient with bothrops snakebite-induced acute kidney injury. Simultaneously, the most relevant epidemiological data of said entity, its risk factors, the possible pathophysiological mechanisms that explain its genesis, its diagnosis and clinical management are detailed. The importance of its early identification and timely treatment is highlighted.
Case presentation: We present the case of a 40-year-old female patient who was admitted to a fourth level of complexity institution due to acute kidney injury and consumption coagulopathy secondary to bothrops snakebite, with the presence of vaginal bleeding and hematuria that progressed to anuria and hematemesis; requiring transfusion of blood products and renal replacement therapy, measures with which she presented a favorable clinical evolution.
Conclusion and discussion: Acute kidney injury associated with the bite of bothrops snakes is a common and life-threatening clinical complication that should not be overlooked. The pathophysiological events responsible for this complication include immunological mechanisms, coagulation disorders, pigmenturia, direct nephrotoxicity, and the inflammatory response with systemic and renal hemodynamic effects. Knowledge of this entity is essential in order to recognize it early and establish its timely treatment in order to reduce its potentially fatal complications.
Albuquerque PLMM, Paiva JHHGL, Martins AMC, Meneses GC, Da Silva GB, Buckley N, et al. Clinical assessment and pathophysiology of Bothrops venom-related acute kidney injury: A scoping review. J Venom Anim Toxins Incl Trop Dis. 2020;26 (July 2020):1–17. https://doi.org/10.1590/1678-9199-jvatitd-2019-0076
Castrillón-Estrada DF, Acosta Vélez JG, Hernández-Ruiz EA, Alonso Palacio LM. Envenenamiento ofídico. Salud Uninorte. 2007; 23 (1): 96-111
Aroca Martínez GA, Guzmán Freja A, Hernández Ruiz EA, Campo Bautista EM, Guarín Navas EG. Insuficiencia renal aguda inducida por mordedura de serpiente Bothrops. Salud Uninorte. 2014; 30 (2): 258-261 https://doi.org/10.14482/sun.30.2.6494
Guzman Freja A, Aroca G. Insuficiencia renal aguda inducida por mordedura de serpiente bothrops: reporte de un caso. Biociencias. 2014; 9(1):53-8.
Rodrigues Sgrignolli L, Florido Mendes GE, Carlos CP, Burdmann EA. Acute kidney injury caused by bothrops snake venom. Nephron Clin Pract. 2011; 119(2):c131-6; discussion c137. https://doi.org/10.1159/000324228
Pinho FM, Yu L, Burdmann EA. Snakebite-induced kidney injury in Latin America. Semin Nephrol. 2008 Jul; 28 (4): 354-62. https://doi.org/10.1016/j.semnephrol.2008.04.004
Albuquerque PLMM, Jacinto CN, Silva Junior GB, Lima JB, Veras MDSB, Daher EF. Lesão renal aguda causada pelo veneno das cobras Crotalus e Bothrops: Revisão da epidemiologia, das manifestações clínicas e do tratamento. Rev Inst Med Trop Sao Paulo. 2013;55(5):295–301. .https://doi.org/10.1590/S0036-46652013000500001
Albuquerque PLMM, Junior GB da S, Meneses GC, Martins AMC, Lima DB, Raubenheimer J, et al. Acute kidney injury induced by bothrops venom: Insights into the pathogenic mechanisms. Toxins (Basel). 2019;11(3):1–14. https://doi.org/10.3390/toxins11030148
Priyamvada PS, Jaswanth C, Zachariah B, Haridasan S, Parameswaran S, Swaminathan RP. Prognosis and long-term outcomes of acute kidney injury due to snake envenomation. Clin Kidney J. 2019:1-7. https://doi.org/10.1093/ckj/sfz055
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