Manifestações clínicas e fatores de risco para comprometimento da função renal em pacientes vítimas de acidentes com serpentes peçonhentas

Abstract

Introduction: Envenomation by venomous snakes is a neglected disease in tropical countries. Acute kidney injury (AKI) is one of the main causes of morbidity and mortality in these cases. The aim of this study was to investigate the occurrence of AKI by snake bites, to evaluate the clinical manifestations and classify the AKI and the involved risk factors. Methods: A retrospective study was conducted with patients victims of snakebites admitted to a reference center. Patients with and without AKI were compared, and AKI was defined according to the RIFLE and AKIN criteria. Statistical analysis was performed by the program SPSS and it was considered significant p<0.05. Results: A total of 276 patients were included, with 83.7% (n= 230) male and 85.5% (n= 146) from rural área. AKI was observed in 15.2% of cases. The mean genus involved in the accidents was Bothrops (82.2%). Mean age of patients with AKI was higher than in patients without AKI (43±20 vs. 34±21 years, p=0.015), respectively. Time between the accident and the medical care was higher in the AKI group (25±28 vs. 14±16h, p=0.034), as well as the time between the accident and the administration of antiofidic sera (30.7±27 vs. 15±16h, p=0.01) and the length of hospital stay (9.1±7.7 vs. 3.2±2.2 days, p<0.01), respectively. Patients with AKI were classified as “Risk” (28.5%), “Injury” (11.9%) and “Failure” (57.1%), and as AKIN1 (35.7%), AKIN2 (7.1%) and AKIN 3 (57.1%). The mean values of creatinine and urea at admission and during hospital stay were higher in the worst stages of RIFLE and AKIN. Potassium at admission was higher in RIFLE-F and AKIN 3 (p=0.045). Hemoglobin was lower in patients classified within the worst staged of RIFLE and AKIN (p=0.041; p=0.042). Hemodialysis was required for 30% of cases, and complete renal function recovery was observed in 54.8% of cases. There were 4 deaths, of whom no one had AKI. Risk factors for AKI were hemorrhagic abnormalities (p=0.036, OR=6.718, 95% CI 1.067–25.661) and a higher lenght of hospital stay (p=0.004, OR=1.69, 95% CI 1.165–2.088). Conclusion: AKI is an importante complication of these acidentes, with low mortality, but with high morbidity, that can lead to partial renal function recovery.