Clinical assessment and pathophysiology of Bothrops venom-related acute kidney injury: a scoping review

Abstract Bothrops are one of the most common medically important snakes found in Latin America. Its venom is predominantly hemotoxic and proteolytic, which means that local lesion (edema and redness) and hemorrhagic symptoms are recurrent in envenoming by this snake. Although hemorrhage is usually the major cause of death, snakebite-related acute kidney injury is another potentially fatal clinical complication that may lead to chronic kidney disease. The present review highlights the main studies on Bothrops venom-related acute kidney injury, including observational, cross-sectional, case-control and cohort human studies available up to December 2019. The following descriptors were used according to Medical Subject Headings (MeSH): on Medline/Pubmed and Google Scholar “acute kidney injury” or “kidney disease” and “Bothrops”; on Lilacs and SciELO “kidney disease” or “acute kidney injury” and “Bothrops”. Newcastle-Ottawa quality assessment scale was used to appraise the quality of the cross-sectional and cohort studies included. The selection of more severe patients who looked for health care units and tertiary centers is a risk of bias. Due to the methodological heterogeneity of the studies, a critical analysis of the results was performed based on the hypothesis that the design of the included studies influences the incidence of acute kidney injury. Fifteen human studies (total participants 4624) were included according to stablished criteria. The coagulation abnormalities (hemorrhagic symptoms, abnormal fibrinogen and activated partial thromboplastin time) were associated with acute kidney injury in the most recent studies reported. The findings observed in this review provide up-to-date evidence about the acute kidney injury pathogenesis following Bothrops syndrome. Studies pointed out that coagulation abnormalities comprise the major pathway for acute kidney injury development. This review may improve patient management by primary healthcare providers, allowing earlier diagnosis and treatment of Bothrops venom-related acute kidney injury.

摘要：Bothrops属蛇是拉丁美洲最常见的具有医学重要性的蛇类之一。其毒液以血液毒性和蛋白溶解性为主，这意味着在此蛇咬伤后的中毒过程中，局部损伤（肿胀和发红）及出血症状是反复出现的。尽管出血通常是死亡的主要原因，但与蛇咬相关的急性肾损伤也是可能导致慢性肾脏病的潜在致命临床并发症。本文综述了截至2019年12月关于Bothrops毒液引起的急性肾损伤的主要研究，包括观察性、横断面、病例对照和队列研究。根据医学主题词（MeSH），在Medline/Pubmed和Google Scholar上使用“急性肾损伤”或“肾脏疾病”以及“Bothrops”进行检索；在Lilacs和SciELO上使用“肾脏疾病”或“急性肾损伤”以及“Bothrops”进行检索。采用Newcastle-Ottawa质量评估量表对纳入的横断面和队列研究进行质量评估。选择寻求医疗单位和三级中心治疗的更严重患者存在偏倚风险。由于研究的方枘圆凿，基于假设纳入研究的方案设计会影响急性肾损伤的发生率，对结果进行了批判性分析。根据既定标准，纳入了15项人类研究（总参与者4624人）。最新的研究报道表明，凝血异常（出血症状、纤维蛋白原异常和活化部分凝血活酶时间异常）与急性肾损伤相关。本综述观察到的发现为Following Bothrops综合症后的急性肾损伤发病机制提供了最新的证据。研究指出，凝血异常是急性肾损伤发展的主要途径。本综述可能有助于提高初级保健提供者的患者管理能力，允许更早地进行诊断和治疗由Bothrops毒液引起的急性肾损伤。