Biomarcadores endoteliais e renais e o diagnóstico precoce da injúria renal aguda no envenenamento humano por serpentes Bothrops erythromelas

Abstract

Acute kidney injury (AKI) is a frequent and potentially fatal complication duo to Bothrops snakebite, it late diagnosis of this pathology further worsens the prognosis. The present study aimed to investigate the role of unconventional renal and endothelial biomarkers in AKI pathophysiology, as well as in the early diagnosis and prognosis in patients with envenoming by Bothrops erythromelas snakes. Methods: It is a prospective study with 26 patients victims of confirmed Bothrops erythromelas envenomation attended in the emergency department of a tertiary hospital in the city of Fortaleza, from January 2019 to February 2020. Blood and urine samples were collected concomitantly at 3 different points: on admission (up to 8 h), 12-16 h and 24-28 h post-bite. AKI was defined using the KDIGO (Kidney Disease Improving Global Outcomes) criteria and the patients were divided in 2 groups: AKI and No-AKI. Clinical and renal parameters associated with the evolution and severity of AKI were evaluated. Biomarkers for renal damage (serum NGAL, urinary NGAL and urinary KIM-1) and endothelial biomarkers (Angiopoietin 1 (Ang-1), Angiopoietin 2 (Ang-2), VCAM-1 and Syndecan-1) were quantified. ROC curves and risk factors for AKI were investigated. Result: Most of the 26 patients were male (88,4%), aged 46,6 (±14,0) years, and the mean time from the snakebite to hospital admission was 6 h 28 min. 54% of patients developed mild AKI. AKI group had a higher number of patients with incoagulable blood tests (85,71%). Statistically significant differences were observed 12-16 h post-bite in the AKI and NoAKI groups with VCAM-1 (1235,63 ± 519 ng/mL versus 818,34 ± 239,56 ng/mL, p=0,027) and Ang-1 (20,48 ng/mL (13,13 – 21,76) versus 1,06 ng/mL (0,52 – 2,56), p= 0,016) biomarkers. Angiopoietin-1 (AUC-ROC= 0,82 (CI 95%: 0,62-1,0)) and VCAM-1 (AUC-ROC= 0,76 (CI 95%: 0,55-0,98)) were good predictors of AKI 12-16 h after Bothrops erythromelas envenomation. Conclusions: The use of endothelial biomarkers VCAM-1 and Ang-1 within 12-16 h post-bite may be useful in the early stage of mild AKI related to Bothrops erythromelas envenoming, and might direct the management of clinical interventions for renal protection in these envenomations.