Clinical profile and outcome of toxin induced acute kidney injury

Jegan, A (2014) Clinical profile and outcome of toxin induced acute kidney injury. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Snake bites, insect stings (animal toxin), chemical poisoning and plant poisoning are one of leading causes of AKI among patients presenting at a tertiarycare hospital in India. Although AKI is relatively less prevalent in India than other tropical diseases the patients have a mean age of 30 to 40 years, which is young compared with patients in developed countries. In a prospective study conducted by Rajenderan et al. in 2007 among patients admitted in tertiary care toxicology unit nearly 68.75% were related to snake bites particularly Russell's viper. Copper sulfate, rat killer, hair dye, indigenous medicine, dichromate etc are also swallowed in suicide attempts. Wasp and scorpion stings also were responsible renal injury. Snake envenomation is a significant public health problem in India. Some practitioners prescribe medicines and herbs contaminated with heavy metals, toxic chemicals, pesticides, or poisonous plants picked in error. Delay in administering the anti venom and incomplete dosage further increases the risk for AKI. Similarly, AKI associated with bites and stings has a better prognosis than AKI associated with chemical poisoning, AIM OF THE STUDY: 1. To study the clinical profile and outcome in toxin induced acute kidney injury. 2. To find out incidence of AKI among poison cases. 3. To do histopathological study in needed cases and its correlation with the outcome. 4. To study about correlation of early decontamination and severity of renal failure. 5. To follow up the patients and to find out the incidence of CKD in this group. MATERIALS AND METHODS: In this study we had selected all cases who had developed renal failure after toxin ingestion or animal bite (snake, wasp sting and scorpion). In this prospective study cases admitted to the Poison Control, Training and Research Centre of Government General Hospital, Madras Medical College were monitored and evaluated for development of AKI. RESULTS AND OUTCOME: Total number of cases during the study period was 4125. Total number of death during the period was 264(6%). Total case presented with renal failure is 178(4.3%). Total number of cases with dialysis requirement is 130(83%). Total number of cases not requiring dialysis was 48 (17%). Total number of males is 115(64%). Total number of females 63(36%). Total number of death in AKI IS 45(17%). most common cause of death is paraquat 33%. CONCLUSION: Incidence of AKI in our study population was 178 (4.3%) of which dialysis requirement was seen in 130 (83%). Snake bite was the leading cause of toxin induced AKI (46%). Risk factors for the development of AKI in this population include cellulitis, regional lymphadenopathy, presence of fang marks, while predictors of poor outcome were hypotension, DIC and rhabdomyolysis. Early adequate administration of snake anti-venom had reduced the severity of AKI. Type of snake bite particularly pit viper bite had very poor outcome. Paraquat and wasp had very high incidence and mortality among the study group.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinical profile ; outcome of toxin ; induced acute kidney injury.
Subjects: MEDICAL > Nephrology
Depositing User: Kambaraman B
Date Deposited: 11 Jul 2017 05:44
Last Modified: 22 Dec 2018 11:44

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