The kidney histopathological spectrum of patients with kidney injury following Snakebite Envenomation in India: Scoping Review of Five Decades

Abstract

Abstract Introduction: Snakebite is a public health problem leading to about 55,000 deaths every year in India. Kidney injury subsequent to snakebite envenomation is common ( reported prevalence is up to 32%). The current study aims to elucidate the spectrum of kidney histopathology in acute kidney injury (AKI) cases followed by snake bites. Methods: We searched seven electronic database studies to identify studies describing the histopathological findings in the kidney with snakebite envenomation. Two reviewers independently conducted titles and abstract screening as well as full-text evaluation for the final inclusion decision. Data were extracted as per a standardized form and conducted narrative synthesis. Studies done exclusively on autopsy findings, in vitro studies, and case reports were excluded. Results: We retrieved 1810 studies and finally included 28 studies which met the eligibility criteria in the analysis. Most studies were single-centre and the majority were cross-sectional. Overall we included a total of 534 renal biopsies. Russell's viper bite was the commonest cause related to AKI. Acute tubular necrosis was the most common finding followed by acute interstitial nephritis, acute cortical necrosis, and thrombotic microangiopathy. Vasculitis changes in vessels were rarely reported. The clinical presentation and prognosis of the patients were directly proportional to the severity of the renal histopathological lesion. Conclusion: This analysis supports the notion that renal biopsies are of utmost importance to guide prognosis and increase our knowledge about post- snake bite AKI pathophysiology