Poisoning and Envenomation Induced Acute Kidney Injury: A Hospital-Based Study

Overview

Journal Indian J Nephrol

Specialty Nephrology

Date 2025 Mar 10

PMID 40060083

Authors

Arham Khan

Saif Quaiser

Ruhi Khan

Neha Agrawal

Affiliations

Soon will be listed here.

Abstract

Background: Most cases of acute kidney injury (AKI) in the Indian subcontinent are community-acquired. Some causes of AKI like poisonings are unique to the local demographics. This study examined the clinical features, spectrum, and outcomes of AKI in patients with poisoning and evaluated the predictors of mortality.

Materials And Methods: This was a prospective observational study conducted in patients admitted to Jawaharlal Nehru Medical College, Aligarh with an alleged history of poisoning orsnake bite. Relevant history, laboratory tests, mode of treatment, and outcome were recorded for all patients who were followed up after 3 months post discharge.

Results: During the study period, 394 patients were admitted with a provisional diagnosis of poisoning/snake bite analyzed, of whom 56 (14.2%) developed AKI. Final data analysis was done for 51 patients as 5 patients were lost to follow up. Paraquat poisoning was the most common cause of AKI, seen in 12 patients, followed by methanol in 9 patients. Hemodialysis was required in 29 (56.8%) patients. Complete recovery was seen in 33 (64.7%) patients, and 14 patients (27.5%) died during the acute phase of the illness. Late presentation to the hospital and presence of shock (mean arterial pressure <65 mmHg) on presentation were found to be associated with adverse outcomes (mortality/failure of return of renal function at 3 months). The most common cause of death was septic shock seen in 8 patients.

Conclusion: This study, which is probably the first from North India, highlights the fact that cases of poisoning/envenomation-related AKI contribute to a sizeable amount of morbidity/mortality.

References

Ahasan H, Chowdhury M, Azhar M, Rafiqueuddin A . Copper sulphate poisoning. Trop Doct. 1994; 24(2):52-3. DOI: 10.1177/004947559402400203. View

Patel V, Ramasundarahettige C, Vijayakumar L, Thakur J, Gajalakshmi V, Gururaj G . Suicide mortality in India: a nationally representative survey. Lancet. 2012; 379(9834):2343-51. PMC: 4247159. DOI: 10.1016/S0140-6736(12)60606-0. View

. 36th International Symposium on Intensive Care and Emergency Medicine : Brussels, Belgium. 15-18 March 2016. Crit Care. 2016; 20(Suppl 2):94. PMC: 5493079. DOI: 10.1186/s13054-016-1208-6. View

Vikrant S, Jaryal A, Parashar A . Clinicopathological spectrum of snake bite-induced acute kidney injury from India. World J Nephrol. 2017; 6(3):150-161. PMC: 5424437. DOI: 10.5527/wjn.v6.i3.150. View

Ahuja H, Mathai A, Pannu A, Arora R . Acute Poisonings Admitted to a Tertiary Level Intensive Care Unit in Northern India: Patient Profile and Outcomes. J Clin Diagn Res. 2015; 9(10):UC01-4. PMC: 4625313. DOI: 10.7860/JCDR/2015/16008.6632. View

Chang S, Wang Y, Hou Y, Wang I, Hong H, Weng C . Acute kidney injury and the risk of mortality in patients with methanol intoxication. BMC Nephrol. 2019; 20(1):205. PMC: 6554873. DOI: 10.1186/s12882-019-1404-0. View

Abebe A, Kumela K, Belay M, Kebede B, Wobie Y . Mortality and predictors of acute kidney injury in adults: a hospital-based prospective observational study. Sci Rep. 2021; 11(1):15672. PMC: 8329200. DOI: 10.1038/s41598-021-94946-3. View

Forni L, Darmon M, Ostermann M, Oudemans-van Straaten H, Pettila V, Prowle J . Renal recovery after acute kidney injury. Intensive Care Med. 2017; 43(6):855-866. PMC: 5487594. DOI: 10.1007/s00134-017-4809-x. View

Shigidi M, Mohammed O, Ibrahim M, Taha E . Clinical presentation, treatment and outcome of paraphenylene-diamine induced acute kidney injury following hair dye poisoning: a cohort study. Pan Afr Med J. 2015; 19:163. PMC: 4362623. DOI: 10.11604/pamj.2014.19.163.3740. View

10.

Oghabian Z, Williams J, Mohajeri M, Nakhaee S, Shojaeepour S, Amirabadizadeh A . Clinical Features, Treatment, Prognosis, and Mortality in Paraquat Poisonings: A Hospital-Based Study in Iran. J Res Pharm Pract. 2019; 8(3):129-136. PMC: 6830018. DOI: 10.4103/jrpp.JRPP_18_71. View

11.

Selby N, Kolhe N, McIntyre C, Monaghan J, Lawson N, Elliott D . Defining the cause of death in hospitalised patients with acute kidney injury. PLoS One. 2012; 7(11):e48580. PMC: 3487783. DOI: 10.1371/journal.pone.0048580. View

12.

Dinis-Oliveira R, Duarte J, Sanchez-Navarro A, Remiao F, Bastos M, Carvalho F . Paraquat poisonings: mechanisms of lung toxicity, clinical features, and treatment. Crit Rev Toxicol. 2007; 38(1):13-71. DOI: 10.1080/10408440701669959. View

13.

Sabzghabaee A, Eizadi-Mood N, Montazeri K, Yaraghi A, Golabi M . Fatality in paraquat poisoning. Singapore Med J. 2010; 51(6):496-500. View

14.

Hassanian-Moghaddam H, Pajoumand A, Dadgar S, Shadnia S . Prognostic factors in methanol poisoning. Hum Exp Toxicol. 2007; 26(7):583-6. DOI: 10.1177/0960327106080077. View

15.

Chelkeba L, Mulatu A, Feyissa D, Bekele F, Tesfaye B . Patterns and epidemiology of acute poisoning in Ethiopia: systematic review of observational studies. Arch Public Health. 2018; 76:34. PMC: 6027736. DOI: 10.1186/s13690-018-0275-3. View

16.

Lee C, Chang E, Lin J, Weng C, Lee S, Juan K . Risk factors for mortality in Asian Taiwanese patients with methanol poisoning. Ther Clin Risk Manag. 2014; 10:61-7. PMC: 3900329. DOI: 10.2147/TCRM.S51985. View

17.

Kumar V, Nada R, Kumar S, Ramachandran R, Rathi M, Kohli H . Acute kidney injury due to acute cortical necrosis following a single wasp sting. Ren Fail. 2012; 35(1):170-2. DOI: 10.3109/0886022X.2012.741467. View

18.

Thongprayoon C, Petnak T, Kaewput W, Mao M, Boonpheng B, Bathini T . Acute kidney injury in hospitalized patients with methanol intoxication: National Inpatient Sample 2003-2014. Hosp Pract (1995). 2021; 49(3):203-208. DOI: 10.1080/21548331.2021.1882239. View

19.

Kamath S, Gautam V . Study of organophosphorus compound poisoning in a tertiary care hospital and the role of Peradeniya Organophosphorus Poisoning scale as a prognostic marker of the outcome. J Family Med Prim Care. 2022; 10(11):4160-4167. PMC: 8797078. DOI: 10.4103/jfmpc.jfmpc_518_21. View

20.

Hampson E, Pond S . Failure of haemoperfusion and haemodialysis to prevent death in paraquat poisoning. A retrospective review of 42 patients. Med Toxicol Adverse Drug Exp. 1988; 3(1):64-71. DOI: 10.1007/BF03259932. View