Acute kidney injury induced by snakebites in children

Abstract Background: Acute Kidney Injury (AKI) is the main complication of snakebites, most associated with the Bothrops species in South and Central America. However, the reported incidence of AKI induced is not well established in the pediatric population. We aimed to evaluate the frequency of AKI and its risk factors in children victims of Bothrops snakebites. Method: Children aged 0-18 years who were victims of Bothrops snakebites in the state of Santa Catarina - Brazil during the period from 2014 to 2020 were retrospectively enrolled in the study and evaluated for AKI using the Kidney Disease Improving Global Outcomes (KDIGO) definition and staging. Results: 463 cases of bothropic accidents were studied. Of those, 15.9% (n=74) of the patients developed AKI, 94.5% (n=70) of them being classified in stage I. The most affected age group was 8-12 years old (28.3%). Medical care occurred in less than 3 hours in 82.6% of cases. Pain (93.3%) and edema (93.5%) were the main symptoms observed. Complications were: secondary infection (10.7%), compartment syndrome (0.8%) and skin necrosis at the site of the bite (1.7%). In contrast to children who did not develop AKI, chidlren who developed AKI had leukocytosis (p=0.017), alteration of urinalysis (p=0.012), systemic manifestations (p=0.026), severe initial classification (p<0.001), compartment syndrome and local necrosis (p<0.001). Conclusions: There was a statistically significant correlation between the group that developed AKI and a high serum level of leukocytes and alteration of urinalysis, mainly hematuria and proteinuria, as well as the presence of systemic manifestations, severe initial classification, compartment syndrome and local necrosis.