Seminars in Nephrology
Volume 28, Issue 4 , Pages 363-372, July 2008

Snakebite Nephrotoxicity in Asia

  • Talerngsak Kanjanabuch, MD

      Affiliations

    • Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
    • ,
  • Visith Sitprija, MD, PhD

      Affiliations

    • Queen Saovabha Memorial Institute, Bangkok, Thailand.
    • King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
    • Corresponding Author InformationAddress reprint requests to Dr. Visith Sitprija, Queen Saovabha Memorial Institute, 1871 Rama 4 Rd, Bangkok 10330, Thailand.

Summary 

Snakebites have the highest incidence in Asia and represent an important health problem. Clinical renal manifestations include proteinuria, hematuria, pigmenturia, and renal failure. Nephropathy usually is caused by bites by snakes with hemotoxic or myotoxic venoms. These snakes are Russell's viper, saw-scaled viper, hump-nosed pit viper, green pit viper, and sea-snake. Renal pathologic changes include tubular necrosis, cortical necrosis, interstitial nephritis, glomerulonephritis, and vasculitis. Hemodynamic alterations caused by vasoactive mediators and cytokines and direct nephrotoxicity account significantly for the development of nephropathy. Hemorrhage, hypotension, disseminated intravascular coagulation, intravascular hemolysis, and rhabdomyolysis enhance renal ischemia leading to renal failure. Enzymatic activities of snake venoms account for direct nephrotoxicity. Immunologic mechanism plays a minor role.

Keywords: Snakebite, renal failure, tubular necrosis, glomerulonephritis, vasculitis

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PII: S0270-9295(08)00083-1

doi:10.1016/j.semnephrol.2008.04.005

Seminars in Nephrology
Volume 28, Issue 4 , Pages 363-372, July 2008

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