title: Renal ischaemia, transient glomerular leak and acute renal tubular damage in patients envenomed by Russell's vipers (Daboia russelii siamensis) in Myanmar.
abstract: Fifty-two patients who had been bitten by Russell's vipers in Myanmar developed acute renal failure (serum creatinine exceeding 1.3 mg/dL). Thirty-four of them (65%) became oliguric, but the other 18 (35%) maintained a urine output of more than 400 mL/24 h. In oliguric patients, gastrointestinal haemorrhages, renal angle tenderness and conjunctival oedema occurred more commonly, and peak serum creatinine, blood urea nitrogen and the fractional excretion of sodium were significantly higher (P < 0.01) than in non-oliguric patients, indicating a greater degree of renal damage. Urinary concentrations of beta 2 microglobulin and retinol binding protein were raised in most of the patients indicating failure of proximal tubular reabsorption of these proteins, while high urinary N-acetyl glucosaminidase concentrations were consistent with renal tubular damage. Plasma concentrations of active renin were very high, suggesting that renal ischaemia, associated with activation of the renin-angiotensin system, was involved in the development of renal dysfunction.
authors.affiliation: Clinical Research Unit for Snakebite, Department of Medical Research, Yangon, Myanmar.
authors.lastname: Tin-Nu-Swe
authors.lastname: Tin-Tun
authors.lastname: Myint-Lwin
authors.lastname: Thein-Than
authors.lastname: Tun-Pe
authors.forename: J I
authors.initials: JI
authors.lastname: Robertson
authors.forename: B J
authors.initials: BJ
authors.lastname: Leckie
authors.forename: R E
authors.initials: RE
authors.lastname: Phillips
authors.forename: D A
authors.initials: DA
authors.lastname: Warrell
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000328:Adult; D000818:Animals; D003229:Conjunctival Diseases / Q000209:etiology; D004487:Edema / Q000209:etiology; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D007668:Kidney / Q000098:blood supply*; D008297:Male; D009846:Oliguria / Q000209:etiology; D011446:Prospective Studies; D017840:Daboia; D012909:Snake Bites / Q000150:complications*; D014757:Viper Venoms / Q000506:poisoning
chemical_list: D014757:Viper Venoms