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

Acessibilidade / Reportar erro

Brasil

Revista da Sociedade Brasileira de Medicina Tropical

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Short Communication • Rev. Soc. Bras. Med. Trop. 51 (05) • Sep-Oct 2018 • https://doi.org/10.1590/0037-8682-0465-2017 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

Loxoscelism is a clinical condition involving spiders of the genus Loxosceles. One of the most severe complications is acute kidney injury (AKI). This study aimed to investigate AKI and other complications associated with loxoscelism.

METHODS:

We analyzed cases diagnosed with loxoscelism in an area where most accidents were caused by Loxosceles amazonica from January 2010 to December 2015. AKI was defined according to the KDIGO criteria.

RESULTS:

Forty-five patients were recorded: 95.6% presented characteristic necrotic skin lesions and 13.3% AKI.

CONCLUSIONS:

Loxoscelism could cause kidney involvement which is uncommon and could lead to the death of these patients.

Keywords:
Loxoscelism; AKI; Spider bites; Coagulation abnormalities

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

Sociedade Brasileira de Medicina Tropical - SBMT Caixa Postal 118, 38001-970 Uberaba MG Brazil, Tel.: +55 34 3318-5255 / +55 34 3318-5636/ +55 34 3318-5287, http://rsbmt.org.br/ - Uberaba - MG - Brazil
E-mail: rsbmt@uftm.edu.br

Acompanhe os números deste periódico no seu leitor de RSS

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