Acute renal failure after Crotalus durissus snakebite: a prospective survey on 100 patients.
BACKGROUND
Acute renal failure (ARF) is the main cause of death after the South American crotalid snakebite. The aim of this study was to assess the prevalence, risk factors, and characteristics of Crotalus durissus venom-induced ARF.


METHODS
One hundred cases of Crotalus durissus bite were studied from hospitalization to discharge or death. Creatinine clearance (GFR) <60 mL/min/1.73 m(2) in the first 72 hours after snakebite was defined as ARF. Data are expressed as median (range of variation) or%, and were analyzed by univariate analysis and logistic regression.


RESULTS
Twenty-nine patients developed ARF. Of those, 24% required dialysis and 10% died. ARF patients had smaller body surface [1.55 (0.6-2.3) vs. 1.7 (0.6-2.1) m(2), P= 0.0097], received antivenom (AV) later [12 (2-48) vs. 2 (1-14) hours, P < 0.0001], received more AV [190 (90-536) vs. 158 (75-500) mg/m(2), P < 0.0001], presented lower diuresis at admission [62 (0-182) mL/hr vs. 100 (25-325) mL/hr, P= 0.0004], and showed a striking creatine kinase (CK) increase [50,250 (69-424,120) vs. 1108 (88-133,170) U/L, P < 0.0001]. Age <12 years (OR 5.6, P= 0.026), time for AV >2 hours (OR 11.1, P= 0.032), CK at admission >2000 U/L (OR 12.7, P= 0.0009) were identified as independent risk factors for ARF, whereas diuresis at admission >90 mL/hr (OR 0.20, P= 0.014) was an independent protector factor.


CONCLUSIONS
C. durissus venom-induced ARF had high prevalence (29%). Delay for AV treatment, CK at admission >2000 U/L, and age <12 years were independent risk factors for ARF development. Diuresis at admission >90 mL/hr was a protective factor.
Pinho
Fábia M O
FM
Division of Nephrology, University of São Paulo Medical School, São Paulo, and Hospital de Doenças Tropicais (Tropical Diseases Hospital) of Goiânia, Brazil.
Zanetta
Dirce M T
DM
Burdmann
Emmanuel A
EA
D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000818:Animals; D002648:Child; D002675:Child, Preschool; D017839:Crotalus; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012206:Rhabdomyolysis / Q000209:etiology*; D012307:Risk Factors; D012909:Snake Bites / Q000150:complications*