Acute kidney injury due to systemic Loxoscelism: a cross-sectional study in Northeast Brazil

Albuquerque, Polianna Lemos Moura Moreira; Tessarolo, Louise Donadello; Menezes, Fernanda Holanda; Lima, Thayanne Barreto de; Paiva, José Hícaro Hellano Gonçalves Lima; Silva Júnior, Geraldo Bezerra da; Martins, Alice Maria Costa; Daher, Elizabeth de Francesco

doi:10.1590/0037-8682-0465-2017

person Polianna Lemos Moura Moreira Albuquerque

schoolPrograma de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil. schoolHospital Instituto Doutor Jose Frota, Prefeitura Municipal de Fortaleza, Fortaleza, CE, Brasil.

person Louise Donadello Tessarolo

schoolPrograma de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Ceará, Fortaleza, CE, Brasil.

person Fernanda Holanda Menezes

schoolFaculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.

person Thayanne Barreto de Lima

schoolFaculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.

person José Hícaro Hellano Gonçalves Lima Paiva

schoolFaculdade de Medicina, Universidade Estadual do Ceará, Fortaleza, CE, Brasil.

person Geraldo Bezerra da Silva Júnior

schoolProgramas de Pós-Graduação em Saúde Coletiva e Ciências Médicas, Faculdade de Medicina, Universidade de Fortaleza, Fortaleza, CE, Brasil.

person Alice Maria Costa Martins

schoolPrograma de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Ceará, Fortaleza, CE, Brasil.

person Elizabeth de Francesco Daher

schoolPrograma de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.

Corresponding author: Dra. Polianna Lemos Moura Moreira Albuquerque
e-mail:
pollylemos78@gmail.com

Conflict of interest: The authors declare that there is no conflict of interest.

Clinical characteristics	Number (n = 45)	Percentage
AKI	6	13.3
dialysis	1	2.2
Non-AKI	39	86.7
coagulation abnormalities	8	17.8
necrotic skin lesions	43	95.6
secondary infections complications	24	53.3
antibiotic administration	27	60.0
corticoids administration	14	31.1
antivenom administration	35	77.8
Dosage, mean (SD)	4.8 (2.5)
Death	2	4.44

	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5	Patient 6
Laboratory parameters	75 years	38 years	72 years	42 years	60 years	47 years
	old,	old,	old,	old,	old,	old,
	female	female	male	male	female	male
Initial Hb, g/dl	12.6	13.4	13.6	7.6	15	6.7
Lowest Hb, g/dl	8.1	12.9	11.9	7.6	12.8	6.1
Hematocrit, %	35.2	39.7	39.2	26.6	38	21
Platelets, mm³	140,000	525,000	224,000	37,000	95,000	524,000
Leukocytes, mm³	10,590	31,260	10,740	46,430	7,100	22,410
PT, seg	12.7	17	11.6	14.5	14.9	15.6
aPTT, seg	46.7	44.9	26	38.4	53.9	40.4
Baseline creatinine, mg/dl	0.4	0.6	0.6	1.3	1.9	1.8
Peak creatinine, mg/dl	2.5	1.5	0.9	6.8	3.1	2.8
Initial urea, mg/dl	68	48	33	21.3	126	103
Peak urea, mg/dl	95	64	34	218	162	141
Initial sodium, mmol/l	127	134	140	123	134	131
Peak sodium, mmol/l	151	159	**	133	134	147
Initial potassium, mEq/l	3.29	4.9	3.8	5.2	5.4	5.68
Peak potassium, mEq/l	4.25	4.9	**	5.8	5.4	5.68
Initial magnesium, mg/dl	**	2.03	2.2	2.5	**	**
Peak magnesium, mg/dl	2.04	2.27	**	2.9	**	**
Initial calcium, mg/dl	7.7	8.4	9.3	6.6	**	9.7
Peak calcium, mg/dl	8.5	9.5	**	9.5	**	9.7
Initial CPK, U/l	268	187	**	797	**	17
Peak CPK, U/l	268	651	**	797	**	406
Initial C-reactive protein, mg/l	369	275	**	142	**	272
Peak C-reactive protein, mg/l	369	275	**	142	**	308
Initial bilirubin total, mg/dl	0.88	**	**	1.6	**	**
Peak bilirubin total, mg/dl	0.88	**	**	2.3	**	**
Initial amylase, U/l	18	678	**	49	**	114
Peak amylase, U/l	**	678	**	254	**	114
Initial lipase, U/l	**	1504	**	45	**	10
Peak lipase, U/l	**	1504	**	317	**	16
Peak glucose, mg/dl	142	539	120	102	128	114

	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5	Patient 6	França et al. (2002)¹³	Nag et al. (2014)⁹
Nausea, vomiting, and malaise	yes	yes	yes	yes	yes	yes	yes*	yes
Acute dermal inflammation or ulceration**	yes	yes	yes	yes	yes	yes	yes*	yes
Debridement and grafting	yes	yes	yes	yes	no	yes	no*	no
Drugs	antibiotic,	antibiotic,	antivenom	antibiotic,	antibiotic,	antibiotic	antibiotic,	antibiotic,
	antivenom	antivenom	and	antivenom,	antivenom	and	antivenom and	antivenom
	and corticoid	and corticoid	antibiotic	diuretics, and corticoid	and corticoid	antivenom	corticoid*	and corticoid
Complications	infection	infection,	infection	infection,	infection	infection	infection,	infection,
	and blood	pancreatitis		hemodialysis	and	and blood	hemodialysis	hemodialysis
	transfusion	and intubation		and blood transfusion	intubation	transfusion	and blood transfusion*	and blood transfusion
Comorbidities	absent	diabetes and arterial	absent	HIV	absent	absent	absent*	absent
		hypertension
Clinical outcome	discharge	discharge	discharge	discharge	death	death	discharge*	discharge

[TFN1] AKI: acute kidney injury; SD: standard deviation.