Camilla N. Jacinto

ACUTE KIDNEY INJURY CAUSED BY Crotalus AND Bothrops SNAKE VENOM: A REVIEW OF EPIDEMIOLOGY, CLINICAL MANIFESTATIONS AND TREATMENT

SUMMARY Ophidic accidents are an important public health problem due to their incidence, morbidity and mortality. An increasing number of cases have been registered in Brazil in the last few years. Several studies point to the importance of knowing the clinical complications and adequate approach in these accidents. However, knowledge about the risk factors is not enough and there are an increasing number of deaths due to these accidents in Brazil. In this context, acute kidney injury (AKI) appears as one of the main causes of death and consequences for these victims, which are mainly young males working in rural areas. Snakes of the Bothrops and Crotalus genera are the main responsible for renal involvement in ophidic accidents in South America. The present study is a literature review of AKI caused by Bothrops and Crotalus snake venom regarding diverse characteristics, emphasizing the most appropriate therapeutic approach for these cases. Recent studies have been carried out searching for complementary therapies for the treatment of ophidic accidents, including the use of lipoic acid, simvastatin and allopurinol. Some plants, such as Apocynaceae, Lamiaceae and Rubiaceae seem to have a beneficial role in the treatment of this type of envenomation. Future studies will certainly find new therapeutic measures for ophidic accidents.

Dengue Fever Among Renal Transplant Recipients: A Series of 10 Cases in a Tropical Country

This is a case series of 10 consecutive renal allograft recipients, followed at a tertiary hospital in northeast Brazil, with a confirmed diagnosis of dengue. Five of the patients needed hospitalization. Half of them were males and age ranged from 19 to 60 years with a median of 38.2 years. They had been transplanted for a mean of 5 days to 166 months. Four patients developed dengue hemorrhagic fever (DHF). All patients had myalgia and headache. All of them, except one, had fever. Positive dengue serology (IgM) was found in all patients. No patient died. Dengue is an important infectious disease that can affect renal transplant recipients, mainly in endemic areas. Its presentation seems to be similar to that seen in immunocompetent patients.

Acute kidney injury after snakebite accident treated in a Brazilian tertiary care centre.

Acute kidney injury (AKI) is one of the main causes of morbidity and mortality in cases of envenomation by venomous snakes. The present study was carried out to investigate the clinical and laboratory manifestations in accidents with venomous snakes and the risk factors associated with AKI in these accidents.

Comparative analysis of pediatric and adult visceral leishmaniasis in Brazil.

Background: The aim of this study was to compare clinical manifestations, laboratory data, morbidity and mortality between adults and children with visceral leishmaniasis, with a focus on kidney function. Methods: This was a retrospective cohort study with 432 patients with visceral leishmaniasis diagnosed at 1 center in the northeast of Brazil. Patients were divided into 2 groups according to age (>21 years and ⩽21 years old). Results: The time between onset of symptoms and beginning of treatment was longer in adults (89.5 versus 48.5 days, P < 0.001); signs and symptoms were similar in both groups. Failure of treatment with glucantime was more common in adults (17.6% versus 8.8%, P = 0.008). Acute kidney injury was observed in 160 patients (37.0%), and it was more severe in adults. Risk factors for acute kidney injury in adults were hypokalemia, leukopenia, chills and amphotericin B use. In children, secondary infections were found to increase the risk for acute kidney injury. Overall mortality was 8.8%, and it was significantly higher in adults (12.6% versus 4.1%, P = 0.002). Conclusions: The adult population had more severe laboratory abnormalities and a worse prognosis, possibly due to delay in diagnosis. Acute kidney injury is prevalent in both groups, and it is usually more severe in adults.

Differences among children, adolescents and adults with severe leptospirosis: A comparative analysis

Leptospirosis is a zoonosis of global importance caused by Leptospira interrogans. The aim of this study was to compare the data between children, adolescents and adults with leptospirosis. This is a retrospective study including a total of 373 consecutive patients with leptospirosis, admitted to tertiary hospitals in Northeast of Brazil, from May 1985 to August 2010. The patients were divided into two groups (age ≤21 years and >21 years). The adults were 304 (81.5%) of the population, with a mean ge of 41 ± 13 (range 22-84) years. The pediatric group was 16 ± 3 (range 9-21) years. Signs and symptoms where similar between the groups, excepting arrhythmia, which was more frequent in adults and vomiting, more common in children (16% vs. 0%, P = 0.04 and 65% vs. 79%, P = 0.02), respectively. Adult group presented with higher serum urea (137 vs. 97 mg/dl, P = 0.002) and creatinine (4.3 vs. 3.0 mg/dl, P = 0.007). Acute kidney injury (AKI) was observed in 80%, mainly in adults (83% vs. 70% P < 0.005). Adults required renal replacement therapy more frequently than children (38% vs. 11%, P < 0.0001). Mortality was higher in adults (14.8% vs. 2.8%, P = 0.005) and in adults with AKI (93% vs. 7%, P < 0.05). There are important differences between the adults and children with leptospirosis. AKI was more frequent in adults and it was associated with increased mortality.

EPIDEMIOLOGICAL PROFILE OF SNAKEBITE ACCIDENTS IN A METROPOLITAN AREA OF NORTHEAST BRAZIL

SUMMARY The aim of this study was to describe the epidemiological profile of snakebite accidents reported by the toxicological assistance center in Fortaleza, Ceará, Brazil. Database information on snakebite accidents was analyzed regarding the period from January 2003 to December 2011. A total of 1063 cases were found. The accidents occurred during the rainy months (March, April and May), in urban areas (52.3%), affecting individuals younger than 50 years and predominantly among males (70.7%). The lower limbs were the most frequently affected body area (33.7%). Most accidents involved non-venomous snakes (76.1%). The genus Bothrops was the main one involved in venomous accidents (83%). It is expected that this study can be used as the substrate to improve healthcare surveillance and implementing better measures for the treatment of this population.

Investigation of urinary abnormalities and risk factors for kidney disease in the World Kidney Day campaigns in Northeast Brazil

Objetivo: a doenca renal cronica (DRC) e um problema crescente no mundo em razao do crescimento exponencial do diabetes mellitus, da hipertensao e de outros fatores de risco. O objetivo deste estudo e investigar alteracoes urinarias e fatores de risco para doenca renal na populacao geral. Metodos: este estudo foi realizado a partir de dados coletados durante as campanhas anuais do Dia Mundial do Rim, em Fortaleza, Ceara, Brasil, entre 2009 e 2012. A populacao buscou atendimento espontaneamente nos stands montados em locais de alto trafego de pessoas. Resultados: entre 2.637 individuos entrevistados, a media de idade foi de 50,7±15,7 anos, sendo 53% do genero masculino. Os principais fatores de risco encontrados foram sedentarismo (60,7%), obesidade (22,7%) e tabagismo (19,8%). Pressao arterial (PA) > 140x90 mmHg foi encontrada em 877 casos (33%). Aumento da PA foi encontrado pela primeira vez em 527 casos (19,9%). Doencas cardiovasculares foram relatadas por 228 individuos (8,6%). Diabetes foi relatado por 343 individuos (13%). Glicemia capilar > 200 mg/dL foi encontrada em 127 casos (4,8%) e > 200 mg/dL pela primeira vez em 30 (1,13%). O exame de urina foi realizado por 1.151 pessoas, sendo encontrada proteinuria em 269 casos (23,3%). Proteinuria foi mais frequente em pessoas com hipertensao (77,3% vs. 55,8%, p = 0,0001), diabetes mellitus (22,7% vs. 15,2%, p = 0,005) e em idosos (42,1% vs. 30,7%, p = 0,0007). Conclusao: fatores de risco para DRC sao frequentes na populacao geral. Muitos individuos tinham hipertensao e diabetes e nao sabiam disso. E importante a realizacao de acoes como o Dia Mundial do Rim com o objetivo de detectar precocemente potenciais candidatos a DRC.

Acute kidney injury after snakebite accident treated in a tertiary care center

Acute kidney injury (AKI) is one of the main causes of morbidity and mortality in cases of envenomation by venomous snakes. The present study was carried out to investigate the clinical and laboratory manifestations in accidents with venomous snakes and the risk factors associated with AKI in these accidents.

Tuberculosis after kidney transplantation is associated with significantly impaired allograft function

This study aimed to evaluate renal function before, during, and after the course of tuberculosis (TB) disease in kidney transplant recipients, and assess the risk factors for non‐recovery of baseline renal function.

Acute kidney injury after snakebite accident treated in a Brazilian tertiary care centre: Acute kidney injury after snakebite

Acute kidney injury (AKI) is one of the main causes of morbidity and mortality in cases of envenomation by venomous snakes. The present study was carried out to investigate the clinical and laboratory manifestations in accidents with venomous snakes and the risk factors associated with AKI in these accidents.