蛇毒毒素致肾损伤研究进展

Progress of Renal Injury Induced by Snake Venom

肾损伤是蛇咬伤常见的严重并发症之一。蛇毒直接导致肾灌注压改变、肾小球病变、肾小管坏死。间接的发病机制包括溶血、纤维蛋白溶解、横纹肌溶解等。细胞因子可能与肾损伤有关。肾脏病理改变为肾小球基底膜溶解、肾小管坏死、皮质坏死。其临床表现为蛋白尿、血尿、酱油色尿,甚至肾衰竭。基本的治疗是尽早使用抗蛇毒血清。

Renal injury is one of the severe and common complications in snakebite. Venom directly results in the changes in renal perfusion pressure, glomerular lesion, and renal tubular necrosis. Indirect mechanisms include the incidence of hemolysis,fibrinolysis and rhabdomyolysis. Cytokines may be related to kidney damage. Renal pathological changes include mesangiolysis,tubular necrosis,cortical necrosis, glomerulonephritis,and interstitial nephritis. Clinical renal manifestations vary from mild proteinuria, hacmaturia, pigmenturia to acute renal failure. Antivenom in appropriate dose is the primary treatment as early as possible.