Acute kidney injury caused by venomous animals: inflammatory mechanisms

 

Naila Albertina de Oliveira1,2, Simone Cristina Cardoso3, Dulce Aparecida Barbosa4, Cassiane Dezoti da Fonseca4

 

1 Department of Nursing, Institute of Health Sciences, Paulista University (Unip), Jundiaí, SP, Brazil.

2 Graduate Program in Nursing, School of Nursing, Federal University of São Paulo (Unifesp), São Paulo, SP, Brazil.

3 Irmandade da Santa Casa de Misericórdia de Piracicaba, Piracicaba, SP, Brazil.

4 Department of Clinical and Surgical Nursing, School of Nursing, Federal University of São Paulo (Unifesp), São Paulo, SP, Brazil.

 

Abstract

Either bites or stings of venomous animals comprise relevant public health problems in tropical countries. Acute kidney injury (AKI) induced by animal toxins is related to worse prognostic and outcomes. Being one the most important pathways to induce AKI following envenoming due to animal toxins, inflammation is an essential biological response that eliminates pathogenic bacteria and repairs tissue after injury. However, direct nephrotoxicity (i.e. apoptotic and necrotic mechanisms of toxins), pigmenturia (i.e. rhabdomyolysis and hemolysis), anaphylactic reactions, and coagulopathies could contribute to the renal injury. All these mechanisms are closely integrated, but inflammation is a distinct process. Hence, it is important to improve our understanding on inflammation mechanisms of these syndromes to provide a promising outlook to reduce morbidity and mortality. This literature review highlights the main scientific evidence of acute kidney injury induced by bites or stings from venomous animals and their inflammatory mechanisms. It included observational, cross-sectional, casecontrol and cohort human studies available up to December 2019. Descriptors were used according to Medical Subject Headings (MeSH), namely: “Acute kidney injury” or “Venom” and “Inflammation” on Medline/Pubmed and Google Scholar; “Kidney disease” or “Acute kidney injury” on Lilacs and SciELO. The present review evidenced that, among the described forms of renal inflammation, it can occur either directly or indirectly on renal cells by means of intravascular, systemic and endothelial hemolysis, activation of inflammatory pathway, as well as direct action of venom cytotoxic components on kidney structures.

 

Keywords: Envenoming Venom Inflammatory process Snake Lonomia Scorpion

 

Correspondence: nailaa.oliveira@gmail.com

 

Received: 09 January 2021; Accepted: 15 April 2021; Published online: 25 August 2021