Crotalus Snake Venon Induced Acute Renal Failure: Clinical Picture and Risk Factores - A Prospective Study. 
F.M.O. Pinho, E.A. Burdmann. Hospital das Clinicas, Univ. Federal de Goias; Division of Nephrology, Sao Jose do Rio Preto Medical School, Brazil.

ARF is the most harmful complication after Crotalus snake bite. In order to assess the clinical picture and risk factors for ARF, 28 consecutive patients bitten by the South American rattlesnake (Crotalus durissus) were prospectively studied at a Tropical Medicine Hospital in Brazil, from July 98 to May 99. The following parameters were evaluated in all patients at admission (adm) and for the next 3 days: gender, age, body
surface (BS), bite site, creatinine clearance (ClCr) nadir, diuresis (D), maximum fractional excretion of sodium (FeNamax), serum creatinine phosphokinase (CPK), serum glutamic-oxaloacetic transaminase
(SGOT) and time until antivenom was delivered (help time). ARF was defined as ClCr<60 ml/min/1.73 m2 in the first 3 days. Patients with ARF were followed until recovery. Results are shown bellow (mean ± SE,
Mann-Whitney, Fisher):

There were no statistically significant differences between the 2 groups regarding gender, bite site and BS. Dialysis was required in 33.3% of the ARF patients. There were no deaths. The renal function at discharge in the ARF group was 67.9 ± 9.9 vs. 116.6 ± 3.6 ml/min/1.73 m2 in the group without ARF (p<0.0003). Conclusions: Acute renal failure after Crotalus durissus bite has a high prevalence (21.4%), occurs early and is associated with high FeNa, denoting proximal tubule injury. These results suggest that delay to receive antivenom, degree of rhabdomyolysis at admission (indicated by CPK and SGOT levels) and younger age are risk factors for the development of acute renal failure after Crotalus durissus snake bite.

Poster Session: Acute Renal Failure and Toxic Nephropathy: Treatment and Outcomes (9:00 AM-4:30 PM)

Presentation Date: Saturday, November 6, 1999, Time: 9:00AM, Room: Halls B and C