02469nas a2200253   4500000000100000008004100001260003400042653002400076653002700100653001400127653001500141653001600156653002000172100001800192700001800210700001900228700002000247245012200267856015300389300001200542490000800554520162800562022002502190       2025                            d  bOxford University Press (OUP)10aAcute Kidney Injury10aChronic kidney disease10asnakebite10aSouth Asia10anephrotoxic10arenal histology1 aAlvitigala BY1 aGooneratne LV1 aGnanathasan CA1 aWijewickrama ES00aSnakebite-associated acute kidney injury in South Asia: narrative review on epidemiology, pathogenesis and management  uhttps://academic.oup.com/trstmh/article/119/6/648/7833650?utm_source=etoc&utm_campaign=trstmh&utm_medium=email&nbd=26233277505&nbd_source=campaigner  a648-6640 v1193 a<p>Snakebite-associated acute kidney injury (AKI) poses a significant health burden in the South Asia region, resulting in considerable morbidity and mortality. Multiple factors contribute to the pathogenesis of AKI following snakebites, including hypotension, intravascular haemolysis, disseminated intravascular coagulation, rhabdomyolysis, thrombotic microangiopathy (TMA) and direct nephrotoxicity. Clinical features manifest as anuria, oliguria, haematuria, abdominal pain and hypertension. Diagnosis is supported by elevated serum creatinine levels and urine output monitoring. Renal histology studies revealed a spectrum of lesions, including acute tubular necrosis, renal cortical necrosis, glomerulonephritis and TMA. Management strategies centre around timely administration of antivenom, fluid and electrolyte balance and dialysis to improve renal outcomes. While dialysis has demonstrated efficacy in reducing AKI-related mortality rates, the use of fresh frozen plasma and therapeutic plasma exchange may be the subject of some controversy. Understanding the pathophysiological link between coagulopathy, TMA and AKI is important for tailoring effective treatment approaches. Species-specific randomized controlled trials are imperative to evaluate targeted interventions. In tackling the complexities of snakebite-associated AKI and chronic kidney disease, a multidisciplinary approach integrating clinical management with rigorous research efforts is essential. This collaborative endeavour aims to confront the challenges posed by these conditions and improve patient outcomes in the affected regions.</p>
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