Early identification of acute kidney injury in Russell's viper (Daboia russelii) envenoming using renal biomarkers.
Background Acute kidney injury (AKI) is a major complication of snake envenoming, but early diagnosis remains problematic. We aimed to investigate the time course of novel renal biomarkers in AKI following Russell's viper (Daboia russelii) bites. Methodology/principal findings We recruited a co...
Published in: | PLOS Neglected Tropical Diseases |
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ftdoajarticles:oai:doaj.org/article:cdc76c837d9246c686cacb0d34725268 2024-02-11T10:01:45+01:00 Early identification of acute kidney injury in Russell's viper (Daboia russelii) envenoming using renal biomarkers. Indira Ratnayake Fahim Mohamed Nicholas A Buckley Indika B Gawarammana Dhammika M Dissanayake Umesh Chathuranga Mahesh Munasinghe Kalana Maduwage Shaluka Jayamanne Zoltan H Endre Geoffrey K Isbister 2019-07-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0007486 https://doaj.org/article/cdc76c837d9246c686cacb0d34725268 EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0007486 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007486 https://doaj.org/article/cdc76c837d9246c686cacb0d34725268 PLoS Neglected Tropical Diseases, Vol 13, Iss 7, p e0007486 (2019) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2019 ftdoajarticles https://doi.org/10.1371/journal.pntd.0007486 2024-01-21T01:35:50Z Background Acute kidney injury (AKI) is a major complication of snake envenoming, but early diagnosis remains problematic. We aimed to investigate the time course of novel renal biomarkers in AKI following Russell's viper (Daboia russelii) bites. Methodology/principal findings We recruited a cohort of patients with definite Russell's viper envenoming and collected serial blood and urine samples on admission (<4h post-bite), 4-8h, 8-16h, 16-24h, 1 month and 3 months post-bite. AKI stage (1-3) was defined using the Acute Kidney Injury Network criteria. AKI stages (1-3) were defined by the Acute Kidney Injury Network (AKIN) criteria. There were 65 Russell's viper envenomings and 49 developed AKI: 24 AKIN stage 1, 13 stage 2 and 12 stage 3. There was a significant correlation between venom concentrations and AKI stage (p = 0.007), and between AKI stage and six peak biomarker concentrations. Although most biomarker concentrations were elevated within 8h, no biomarker performed well in diagnosing AKI <4h post-bite. Three biomarkers were superior to serum creatinine (sCr) in predicting AKI (stage 2/3) 4-8h post-bite: serum cystatin C (sCysC) with an area under the receiver operating curve (AUC-ROC), 0.78 (95%CI:0.64-0.93), urine neutrophil gelatinase-associated lipocalin (uNGAL), 0.74 (95%CI:0.59-0.87) and urine clusterin (uClu), 0.81 (95%CI:0.69-0.93). No biomarker was better than sCr after 8h. Six other urine biomarkers urine albumin, urine beta2-microglobulin, urine kidney injury molecule-1, urine cystatin C, urine trefoil factor-3 and urine osteopontin either had minimal elevation, and/or minimal prediction for AKI stage 2/3 (AUC-ROC<0.7). Conclusions/significance AKI was common and sometimes severe following Russell's viper bites. Three biomarkers uClu, uNGAL and sCysC, appeared to become abnormal in AKI earlier than sCr, and may be useful in early identification of envenoming. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 13 7 e0007486 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Indira Ratnayake Fahim Mohamed Nicholas A Buckley Indika B Gawarammana Dhammika M Dissanayake Umesh Chathuranga Mahesh Munasinghe Kalana Maduwage Shaluka Jayamanne Zoltan H Endre Geoffrey K Isbister Early identification of acute kidney injury in Russell's viper (Daboia russelii) envenoming using renal biomarkers. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Background Acute kidney injury (AKI) is a major complication of snake envenoming, but early diagnosis remains problematic. We aimed to investigate the time course of novel renal biomarkers in AKI following Russell's viper (Daboia russelii) bites. Methodology/principal findings We recruited a cohort of patients with definite Russell's viper envenoming and collected serial blood and urine samples on admission (<4h post-bite), 4-8h, 8-16h, 16-24h, 1 month and 3 months post-bite. AKI stage (1-3) was defined using the Acute Kidney Injury Network criteria. AKI stages (1-3) were defined by the Acute Kidney Injury Network (AKIN) criteria. There were 65 Russell's viper envenomings and 49 developed AKI: 24 AKIN stage 1, 13 stage 2 and 12 stage 3. There was a significant correlation between venom concentrations and AKI stage (p = 0.007), and between AKI stage and six peak biomarker concentrations. Although most biomarker concentrations were elevated within 8h, no biomarker performed well in diagnosing AKI <4h post-bite. Three biomarkers were superior to serum creatinine (sCr) in predicting AKI (stage 2/3) 4-8h post-bite: serum cystatin C (sCysC) with an area under the receiver operating curve (AUC-ROC), 0.78 (95%CI:0.64-0.93), urine neutrophil gelatinase-associated lipocalin (uNGAL), 0.74 (95%CI:0.59-0.87) and urine clusterin (uClu), 0.81 (95%CI:0.69-0.93). No biomarker was better than sCr after 8h. Six other urine biomarkers urine albumin, urine beta2-microglobulin, urine kidney injury molecule-1, urine cystatin C, urine trefoil factor-3 and urine osteopontin either had minimal elevation, and/or minimal prediction for AKI stage 2/3 (AUC-ROC<0.7). Conclusions/significance AKI was common and sometimes severe following Russell's viper bites. Three biomarkers uClu, uNGAL and sCysC, appeared to become abnormal in AKI earlier than sCr, and may be useful in early identification of envenoming. |
format |
Article in Journal/Newspaper |
author |
Indira Ratnayake Fahim Mohamed Nicholas A Buckley Indika B Gawarammana Dhammika M Dissanayake Umesh Chathuranga Mahesh Munasinghe Kalana Maduwage Shaluka Jayamanne Zoltan H Endre Geoffrey K Isbister |
author_facet |
Indira Ratnayake Fahim Mohamed Nicholas A Buckley Indika B Gawarammana Dhammika M Dissanayake Umesh Chathuranga Mahesh Munasinghe Kalana Maduwage Shaluka Jayamanne Zoltan H Endre Geoffrey K Isbister |
author_sort |
Indira Ratnayake |
title |
Early identification of acute kidney injury in Russell's viper (Daboia russelii) envenoming using renal biomarkers. |
title_short |
Early identification of acute kidney injury in Russell's viper (Daboia russelii) envenoming using renal biomarkers. |
title_full |
Early identification of acute kidney injury in Russell's viper (Daboia russelii) envenoming using renal biomarkers. |
title_fullStr |
Early identification of acute kidney injury in Russell's viper (Daboia russelii) envenoming using renal biomarkers. |
title_full_unstemmed |
Early identification of acute kidney injury in Russell's viper (Daboia russelii) envenoming using renal biomarkers. |
title_sort |
early identification of acute kidney injury in russell's viper (daboia russelii) envenoming using renal biomarkers. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2019 |
url |
https://doi.org/10.1371/journal.pntd.0007486 https://doaj.org/article/cdc76c837d9246c686cacb0d34725268 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 13, Iss 7, p e0007486 (2019) |
op_relation |
https://doi.org/10.1371/journal.pntd.0007486 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007486 https://doaj.org/article/cdc76c837d9246c686cacb0d34725268 |
op_doi |
https://doi.org/10.1371/journal.pntd.0007486 |
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PLOS Neglected Tropical Diseases |
container_volume |
13 |
container_issue |
7 |
container_start_page |
e0007486 |
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