Acute kidney injury induced by snakebites in pediatric patients

Abstract

Background: Snakebites are a significant public health problem worldwide, with a global prevalence estimated 2.7 million envenomings and 81,000 to 138,000 deaths annually. Acute kidney injury (AKI) is the main complication of snakebites, most associated with the Bothrops species in South and Central America. However, the reported incidence of AKI induced is not well established in the pediatric population. We aimed to evaluate the frequency of AKI and its risk factors in child victims of Bothrops snakebites.

Methods: Children aged 0-18 years who were victims of Bothrops snakebites in Santa Catarina, Brazil, from 2014 to 2020 were retrospectively enrolled and evaluated for AKI using the Kidney Disease Improving Global Outcomes (KDIGO) definition and staging.

Results: A total of 463 cases of bothropic accidents were studied. Of those, 15.9% (n = 74) of patients developed AKI, 94.5% (n = 70) being classified in stage I. The most affected age group was 8-12 years old (28.3%). Medical care occurred in less than 3 h in 82.6% of cases. Pain (93.3%) and edema (93.5%) were the main symptoms observed. Complications were as follows: secondary infection (10.7%), compartment syndrome (0.8%), and skin necrosis at the site of the bite (1.7%). In contrast to children who did not develop AKI, children who developed AKI had leukocytosis (p = 0.017), alteration of urinalysis (p = 0.012), severe initial classification (p < 0.001), compartment syndrome, and local necrosis (p < 0.001).

Conclusion: The frequency of AKI was 15.9%. Risk factors for AKI included severe initial classification, presence of leukocytosis, changes in urinalysis, compartment syndrome, and local necrosis.

Keywords: Bothrops snake; Acute kidney injury; Pediatric kidney failure; Risk factors; Snake bite.