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Toxins 2019, 11(3), 148;

Acute Kidney Injury Induced by Bothrops Venom: Insights into the Pathogenic Mechanisms

Medical Sciences of Post-Graduate Program, Department of Internal Medicine, Federal University of Ceara, CEP 60416-200 Fortaleza, Ceara, Brazil
School of Medicine, Public Health and Medical Sciences Post-Graduate Programs, School of Medicine, University of Fortaleza, CEP 60811-905 Fortaleza, Ceara, Brazil
Center for Toxicological Assistance, Dr. José Frota Institute, CEP 60025-061 Fortaleza, Ceara, Brazil
Pharmacology and Pharmaceutial Sciences Post-Graduate Programs, Federal University of Ceara, CEP 60430-275 Fortaleza, Ceara, Brazil
Clinical Pharmacology, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
Author to whom correspondence should be addressed.
Received: 26 January 2019 / Revised: 26 February 2019 / Accepted: 28 February 2019 / Published: 5 March 2019
(This article belongs to the Section Animal Venoms)
PDF [2904 KB, uploaded 5 March 2019]


Acute kidney injury (AKI) following snakebite is common in developing countries and Bothrops genus is the main group of snakes in Latin America. To evaluate the pathogenic mechanisms associated with Bothrops venom nephrotoxicity, we assessed urinary and blood samples of patients after hospital admission resulting from Bothrops snakebite in a prospective cohort study in Northeast Brazil. Urinary and blood samples were evaluated during hospital stay in 63 consenting patients, divided into AKI and No-AKI groups according to the KDIGO criteria. The AKI group showed higher levels of urinary MCP-1 (Urinary monocyte chemotactic protein-1) (median 547.5 vs. 274.1 pg/mgCr; p = 0.02) and urinary NGAL (Neutrophil gelatinase-associated lipocalin) (median 21.28 vs. 12.73 ng/mgCr; p = 0.03). Risk factors for AKI included lower serum sodium and hemoglobin levels, proteinuria and aPTT (Activated Partial Thromboplastin Time) on admission and disclosed lower serum sodium (p = 0.01, OR = 0.73, 95% CI: 0.57–0.94) and aPTT (p = 0.031, OR = 26.27, 95% CI: 1.34–512.11) levels as independent factors associated with AKI. Proteinuria showed a positive correlation with uMCP-1 (r = 0.70, p < 0.0001) and uNGAL (r = 0.47, p = 0.001). FENa (Fractional Excretion of sodium) correlated with uMCP-1 (r = 0.47, P = 0.001) and uNGAL (r = 0.56, p < 0.0001). sCr (serum Creatinine) showed a better performance to predict AKI (AUC = 0.85) in comparison with new biomarkers. FEK showed fair accuracy in predicting AKI (AUC = 0.92). Coagulation abnormality was strongly associated with Bothrops venom-related AKI. Urinary NGAL and MCP-1 were good biomarkers in predicting AKI; however, sCr remained the best biomarker. FEK (Fractional Excretion of potassium) emerged as another diagnostic tool to predict early AKI. Positive correlations between uNGAL and uMCP-1 with proteinuria and FENa may signal glomerular and tubular injury. Defects in urinary concentrations highlighted asymptomatic abnormalities, which deserve further study. View Full-Text
Keywords: Bothrops; envenomation; acute kidney injury; renal tubular dysfunction; coagulopathy; novel biomarkers Bothrops; envenomation; acute kidney injury; renal tubular dysfunction; coagulopathy; novel biomarkers

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Albuquerque, P.L.M.M.; da Silva Junior, G.B.; Meneses, G.C.; Martins, A.M.C.; Lima, D.B.; Raubenheimer, J.; Fathima, S.; Buckley, N.; Daher, E.D.F. Acute Kidney Injury Induced by Bothrops Venom: Insights into the Pathogenic Mechanisms. Toxins 2019, 11, 148.

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