Acute renal failure in snake envenomation: a large prospective study.

Venomous snakebite is a common problem in India. The aim of this study is to assess the prevalence, risk factors and prognostic factors in snakebite induced acute renal failure and to determine their outcome from a tertiary care center in India. A total of 1548 cases of snakebite admitted to adult medical wards of Government Rajaji hospital from January 2003 to December 2004, were studied from hospitalization to discharge or death. There were 1180 poisonous and 368 nonpoisonous snakebites. Among the poisonous, there were 1121 viperidae and 59 elapidae bites. A total of 159 (13.5%) patients (M = 98, F = 61) developed acute renal failure; of them 72 (45.3%) required dialysis and 36 (22.6%) expired (of them, 23 required dialysis). ARF patients were older than non ARF (39.1 vs. 35.4 years, p = 0.03). Cellulites (OR 9.20, p = 0.032), regional lymphadenopathy (OR 22.0, p= 0.001), intravascular hemolysis (OR 3.70, p = 0.004) and bite to needle time more than 2 hours (OR 2.10, p = 0.001) were identified as independent risk factors for the development of acute renal failure. Bite to needle time more than 2 hours (OR 2.10, p = 0.01), presence of intravascular hemolysis (OR 13.0, p = 0.004) and hypotension (OR 22.2, p = 0.04) and the presence of bleeding manifestations (OR 7.91, p = 0.032) were identified as independent predictors of poor outcome in snakebite victims. We conclude that our study demonstrates several risk factors and predictors for the development and outcome of ARF in patients with snakebites.