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백진기(Jin Ki Paek),유병우(Byung Woo Yu),안영수(Young Soo An),김종봉(Jong Bong Kim),김태준(Tae Jun Kim),김홍수(Hong Soo Kim),최태명(Tae Jun Kim),양동호(Dong Ho Yang),홍세용(Sae Yong Hong),양승하(Seung Ha Yang),이현순(Hyun Soon Lee) 대한내과학회 1994 대한내과학회지 Vol.46 No.4
N/A Objectives: The pathogenesis of acute renal failure developed after snake bite has been variously attributed to the direct renal damage by the venoms, and the secondary effects of disseminated intravascular coagulation, shock, intravascular hemolysis, the defibrination syndrome, and myoglobinuria. We analysed the thirteen cases of renal involvement after snake bite to elucidate possible causes and clinical characteristics of acute renal failure. Method: We reviewed the clinical symptoms, physical examination, laboratory data, and renal biopsies (two cases) in the 13 cases of acute renal failure developed after snake bite among 195 cases during the recent 10 years, Results: 1) The sex ratio of the patients with acute renal failure after snake bite (man: woman) was 1:5.5, presenting female predominance. Most of the cases were over 50 years of age covering more than 90% of the total snake bite cases 2) As respects to the time elapse from the snake bite to the hospital care, four cases were within 1 hour, two cases were within 1~2 hours, two cases were within 3~12 hours, and the rest of them (ten cases) were within 24 hours. 3) The systemic symptoms and signs of snake bite are as follows: nausea, vomiting, dyspnea, macroscopic hematuria, dizziness, headache, altered consciousness, and visual disturbance. Most of the patients complained of localized edema and pain around the wound of snake bite. Oliguria was noted in four patients, and it lasted for 13 days in average. 4) On admission, urinalysis of the patients with acute renal failure showed proteinuria (ten cases) and hematuria (six cases). Most of the patients with renal failure had hyperkalemia, hypocalcemia, elevated SGOT and LDH. The serum BUN and creatinine levels were elevated (more than 2.0 mg/dl and 4.2 mg/dl, respectively) above the normal range. 5) Renal biopsy performed in two cases of convalescent stage showed the findings of acute tubular necrosis with intact glomeruli. 6) Hemodialysis was performed in six patients out of thirteen cases of acute renal failure. 7) Of the thirteen patients with renal failure after snake bite, eight patients improved. But five patients were discharged against our will. All but one (self discharged) of the six patients with hemodialysis were discharged with clinical improvement. Conclusions: Acute renal failure caused by snake bite is not uncommon in Korea. We analysed the thirteen cases of snake bite with acute renal failure that revealed direct renal tubular necrosis on biopsy. And we speculate that the renal damage may be caused by the nephrotoxin of the venom. It is suggested that immediate intervention and preventive measures for renal failure after snake bite are needed.