title: Viper bites complicate chronic agrochemical nephropathy in rural Sri Lanka.
abstract: Snakebite is a common occupational health hazard among Sri Lankan agricultural workers, particularly in the North Central Province. Viperine snakes, mainly Russell's viper envenomation, frequently lead to acute renal failure. During the last two decades, an agrochemical nephropathy, a chronic tubulointerstitial disease has rapidly spread over this area leading to high morbidity and mortality. Most of the epidemiological characteristics of these two conditions overlap, increasing the chances of co-occurrence. Herein, we describe four representative cases of viperine snakebites leading to variable clinical presentations, in patients with chronic agrochemical nephropathy, including two patients presented with acute and delayed anuria. These cases suggest the possibility of unusual manifestations of snakebite in patients with Sri Lankan agrochemical nephropathy, of which the clinicians should be aware. It could be postulated that the existing scenario in the Central America could also lead to similar clinical presentations.
authors.affiliation: Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura 50008, Sri Lanka.
authors.forename: Anjana
authors.initials: A
authors.lastname: Silva
authors.affiliation: Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
authors.forename: Rivikelum
authors.initials: R
authors.lastname: Samarasinghe
authors.affiliation: Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
authors.forename: Senaka
authors.initials: S
authors.lastname: Pilapitiya
authors.affiliation: Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
authors.forename: Niroshana
authors.initials: N
authors.lastname: Dahanayake
authors.affiliation: Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
authors.forename: Sisira
authors.initials: S
authors.lastname: Siribaddana
keywords: Agricultural nephropathy; Anuria; Chronic kidney disease; Epidemiology; Snakebite