A STUDY OF CLINICAL PROFILE AND PREDICTORS OF POOR OUTCOME IN SNAKE BITE INDUCED ACUTE KIDNEY INJURY

Acute kidney injury (AKI) is an important cause of morbidity and mortality among victims of snake bite. This study was aimed to assess clinical profile and to identify predictors of poor outcome in snake bite-induced AKI patients. This is a prospective study, conducted among patients who got admitted with snake bite to BAPUJI HOSPITAL, JJM Medical college, Karnataka,from 1/7/021 to 1/9/2022. Detailed history was taken and clinical examination were done for each case. Relevant investigations includingWhole blood clotting time, complete bloodcount, renal function tests, liver function tests, coagulation profile, serum electrolyte analysis, X-ray of the chest, ultrasonography of the abdomen and urine analysis were done. All patients with local toxicity, hematotoxicity and neurotoxicity were treated with Antisnake venom, intravenous antibiotics and other supportive treatment. Demography,clinical profile, course in the hospital, management aspects and outcome were studied indetail. Patients were followed up till they were discharged to determine the recovery of renal function.Results revealed prevalence of AKIamong the victims of snake bite was 19.44%. The mean age of the snake bite induced AKI patients group was 46.5 ±11.5 and among them 71.42% were male.Common clinical manifestation in AKI group noted were cellulitis in 92.85% of the patients followed by septicaemia(85.71%), regional lymphadenopathy (71%) and gangrene at bite site (64%). Where as in non-AKI group, the cellulitis was noted in 82% followed by regional lymphadenopathy (28%), gangrene at bite site (22%) and septicaemia(13%). In conclusion AKI was found in 19.44% among the victims of snake bite. The common manifestations observed are cellulitis, septicaemia and gangrene at bite site. Delay in administration of ASV, development of coagulopathy, septicaemia, and hypotension were the predictors of poor outcome in snake bite induced acute renal failure.The patients who had visited traditional healers had a higher incidence of developing AKI ,which was supposedly due to delay in receiving ASV. One-third of patients with AKI developed long-term complications like CKD on follow-up. Early recovery from AKI was associated with better preservation of glomerular filtration rate in the long-term.