Acute thrombotic microangiopathic kidney injury due to Echis coloratus envenomation.
Introduction: We describe two cases of Echis coloratus envenomation associated with thrombotic microangiopathic acute kidney injury (AKI). Case presentation: Two patients, 39 and 70 years old, were hospitalized due to E. coloratus envenomation. Both were treated with anti-venom and blood products due to coagulopathy. Several hours after admission both developed acute kidney injury (creatinine 10.63 and 7.63 mg/dL) associated with hemolysis (lactate dehydrogenase 3858 and 2698 U/L) schistocytosis (49 and 6%) and thrombocytopenia (26 and 30 × 103/µL). A disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13 activity was measured only in patient number 2 and was within the normal limits. Both patients were treated with hemodialysis and plasmapheresis (4-6 courses). Both were discharged with normal platelet count, and no hemolysis. Their renal function improved gradually and hemodialysis was discontinued. Discussion: Following E. coloratus envenomation, both patients described developed hemolytic uremic syndrome-like thrombotic microangiopathy, with thrombocytopenia, intravascular hemolysis and severe AKI. Both recovered after combined treatment with hemodialysis and plasmapheresis. Conclusions: E. coloratus envenomation can cause HUS-like TMA.