Early identification of acute kidney injury in Russell’s viper (Daboia russelii) envenoming using renal biomarkers

BackgroundAcute kidney injury (AKI) is a major complication of snake envenoming, but early diagnosis remains problematic. We aimed to investigate the time course of novel renal biomarkers in AKI following Russell’s viper (Daboia russelii) bites.Methodology/Principal findingsWe recruited a cohort of patients with definite Russell’s viper envenoming and collected serial blood and urine samples on admission (Conclusions/SignificanceAKI was common and sometimes severe following Russell’s viper bites. Three biomarkers uClu, uNGAL and sCysC, appeared to become abnormal in AKI earlier than sCr, and may be useful in early identification of envenoming.【背景】急性肾损伤（AKI）是蛇咬伤中毒的主要并发症，其早期诊断仍存在难题。本研究旨在探讨罗素氏蝰蛇（Daboia russelii，Russell’s viper）咬伤后急性肾损伤患者体内新型肾脏生物标志物的时间变化规律。【方法学与主要结果】本研究招募了确诊罗素氏蝰蛇咬伤中毒的患者队列，并收集了患者入院时的系列血液与尿液样本。【结论与意义】罗素氏蝰蛇咬伤后，急性肾损伤较为常见，部分病例病情较为严重。三种生物标志物尿Clu（uClu）、尿NGAL（uNGAL）及血清胱抑素C（sCysC）在急性肾损伤中出现异常的时间早于血清肌酐（sCr），或可用于蛇咬伤中毒的早期识别。