Kidney Week

Abstract: SA-PO531

New Perspectives on Bothrops-Induced AKI: Novel Biomarkers and Coagulation Disturbances

Session Information

• AKI: Clinical, Outcomes, Trials - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Lemos m.m. albuquerque, Polianna, Federal University of Ceara, Fortaleza, Brazil

Polianna Lemos m.m. albuquerque,

• Silva Junior, Geraldo B., University of Fortaleza, Fortaleza, Brazil

Geraldo B. Silva Junior,

• Cavalcante meneses, Gdayllon, Federal University of Ceara, Fortaleza, Brazil

Gdayllon Cavalcante meneses,

• Costa martins, Alice maria, Federal University of Ceara, Fortaleza, Brazil

Alice maria Costa martins,

• Raubenheimer, Jacques, University of Sydney, Sydney, New South Wales, Australia

Jacques Raubenheimer,

• Shihana, Fathima, University of Sydney, Sydney, New South Wales, Australia

Fathima Shihana,

• Buckley, Nicholas, The University of Sydney, Sydney, New South Wales, Australia

Nicholas Buckley,

• De francesco daher, Elizabeth, Federal University of Ceara, Fortaleza, Brazil

Elizabeth De francesco daher,

Background

Bothrops sp is the most common snake genus associated with acute kidney injury (AKI) in Latin America. We evaluated novel biomarkers and coagulation disturbances among patients with Bothrops venom-induced AKI.

Methods

This is a prospective study of patients with snakebite (Bothrops)-induced AKI admitted to a referral emergency hospital in Fortaleza city, Brazil, from December 2015 to December 2016. Biomarkers were measured in blood (sNGAL) and urine (uNGAL, uMCP-1, uKIM-1, VCAM-1 and IL-6) using ELISA.

Results

63 patients were included, and 22 (34.9%) developed AKI. The age, time elapsed between snakebite and administration of antivenom, number of administered antivenom vials, gender distribution and severity of the envenomation were similar in the groups. The biomarkers uMCP-1 and uNGAL were significantly higher in the AKI group: uMCP-1 (471.2 ± 60.40 vs. 288.8 ± 41.42pg/ml; p=0.014) and uNGAL (15.27 ± 1.28 vs. 10.29 ± 1.06ng/ml; p=0.006). The activated partial thromboplastin time (APTT) on admission, was significantly longer in the AKI group (p=0.011). Urinary proteinuria correlated highly with two specific urine biomarkers: uMCP-1 (r=0.5242, p=0.0003) and uNGAL (r=0.4938, p=0.0008). The fractional excretion of sodium (FE_Na) also strongly correlated with uMCP-1 (r=0.8696, p<0.0001) and uNGAL (r=0.6833, p<0.0001). The correlation between FE_Na and uMCP-1was largely confined to the AKI-group (Figure 1). The FE_K also positively correlated with uMCP-1 (r=0.5775, p<0.0001) and uNGAL (r=0.5647, p=0.0001).

Conclusion

Coagulation abnormalities seem to be a pivotal factor in AKI development in Bothrops-induced AKI. The higher levels of uMCP-1 and uNGAL could represent early tubular and glomerular dysfunction caused by snakebite venom, and the abnormalities in fractional excretion of electrolytes point to tubular transport dysfunction.

Funding

• Government Support - Non-U.S.