Nephrotoxicity in snake envenomation.

There is a broad spectrum of renal involvement following snake envenomation. At the clinical level the renal manifestation may be absent or minimal. Mild proteinuria with abnormal urinary sediment may be observed. Significant proteinuria is uncommon. Hematuria and hemoglobinuria are seen in envenomation by vipers or crotalids, while myoglobinuria follows envenomation of sea snakes or elapids. Acute renal failure can occur in these snake bites. All renal structures can be involved. Mesangial proliferative glomerulonephritis is common. Tubular necrosis is the important pathological counterpart of acute renal failure. Three mechanisms including hemodynamic alterations, immunologic reactions, and direct nephrotoxicity are incriminated in the pathogenesis of renal lesions.