Context
Bothrops snakes are the most frequent agents of
snakebites in South and
Central America.
Acute kidney injury (AKI) is one of its
complications and has multifactorial origin.
Thrombotic microangiopathy (TMA)-induced AKI in
snakebites is uncommon and is not described in
Bothrops envenomation. Case details We
report two cases of
patients bitten by young
Bothrops jararaca who developed AKI induced by TMA. Both
patients evolved with mild envenomation and received the specific
antivenom within 4 h after the
snakebite. None of them had
hypotension or
shock,
bleeding or
secondary infection.
Patient 1 (P1) was diabetic and using oral
hypoglycemic drugs, and
patient 2 (P2) was hypertensive without regular use of medication. On admission, both
patients had levels of
fibrinogen lower than 35 mg/dL, D-dimer higher than 10,000 ng/mL. They evolved with AKI,
thrombocytopenia, normal coagulation assays,
anemia,
lactate dehydrogenase (LDH) elevation, low
haptoglobin levels, negative
direct antiglobulin test, and presence of schizocytes in peripheral
blood. Only P1 required
renal replacement therapy, and
plasmapheresis was not required. Both
patients were discharged and did not require
outpatient dialysis, and subsequently had normal
creatinine levels.
Discussion:
TMA may occur in
Bothrops jararaca envenomation, even in mild cases that received early specific
antivenom.