Transactions of the Royal Society of Tropical Medicine and Hygiene
August 27, 2026 · via Europe PMC
Renal histopathology in acute kidney injury following haemotoxic snake envenomation.
Rao PSK, Bammigatti C, Priyamvada PS, Srinivas BH.
AI summary — for doctors, generated from the abstract only
In a modern cohort of patients with snakebite-related acute kidney injury, acute interstitial nephritis was as common as acute tubular necrosis and no cortical necrosis was seen, suggesting the classic histopathological picture of snakebite kidney injury may be shifting toward more treatable lesions.
What was studied
A prospective observational study at a South Indian tertiary center (2022-2024) performing kidney biopsies (in survivors, post-coagulopathy-correction) and autopsy biopsies (in non-survivors) on 18 patients with persistent acute kidney injury after haemotoxic snakebite envenomation.
Key findings
- Acute tubular necrosis and acute interstitial nephritis were equally frequent (38.9% each)
- Thrombotic microangiopathy occurred in 16.7%, pigment nephropathy in 5.5%
- No cases of acute cortical necrosis were identified
- Early corticosteroid treatment of interstitial nephritis was associated with complete renal recovery in some survivors
Clinical relevance
Clinicians managing snakebite-associated AKI should consider renal biopsy to identify interstitial nephritis, since it may respond to corticosteroid therapy, potentially changing management from purely supportive care to targeted anti-inflammatory treatment.
Limitations
Very small sample (18 biopsies) from a single center, no control group, and biopsy timing/corticosteroid use was not standardized, limiting causal claims about treatment benefit.
Biopsy may reveal a steroid-responsive lesion hiding behind snakebite kidney injury.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objectives
Snakebite envenomation is a major cause of acute kidney injury (AKI) in tropical regions. While acute tubular necrosis (ATN) and acute cortical necrosis have traditionally been described as predominant renal lesions, multiple factors, including recent improvements in early access to antivenom, may have altered the histopathological spectrum. This study aimed to evaluate renal histopathology in snakebite envenomation-associated AKI (SBE-AKI) and its clinicopathological correlates.
Methods
In this prospective observational study conducted at a tertiary care centre in South India from September 2022 to July 2024, patients with proven haemotoxic snake envenomation who developed persistent AKI were included. Kidney biopsies were performed in survivors after correction of coagulopathy, and autopsy biopsies were obtained from non-survivors. Histopathological assessment was independently performed by two blinded pathologists.
Results
Eighteen renal biopsy samples were analysed. ATN and acute interstitial nephritis (AIN) were the most frequent lesions (each 38.9%), followed by thrombotic microangiopathy (16.7%) and pigment nephropathy (5.5%). Notably, no cases of cortical necrosis were identified. Early recognition and treatment of AIN with corticosteroids were associated with complete renal recovery in selected survivors.
Conclusion
The predominance of AIN and absence of cortical necrosis suggest an evolving histopathological pattern of SBE-AKI. Early renal biopsy may help identify potentially reversible lesions and improve renal outcomes.
DOI
10.1093/trstmh/trag099
PMID
42657865
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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