Rev. Inst. Med. Trop. Sao Paulo 55(5):295-301, September-October, 2013 doi: 10.1590/S0036-46652013000500001 (1) Toxicological Assistance Center, Instituto Dr. José Frota. Fortaleza, Ceará, Brazil. (2) Post-Graduation Program in Medical Sciences, School of Medicine, Federal University of Ceará. Fortaleza, Ceará, Brazil. (3) School of Medicine, Health Sciences Center, University of Fortaleza. Fortaleza, Ceará, Brazil. Correspondence to: Elizabeth De Francesco Daher. R. Vicente Linhares 1198. 60135-270 Fortaleza, Ceará, Brasil. Phone/Fax: +55 85 32249725, +55 85 32613777. E-mail: ef.daher@uol. com.br, geraldobezerrajr@yahoo.com.br, pollylemos@yahoo.com.br REVIEW ACUTE KIDNEY INJURY CAUSED BY Crotalus AND Bothrops SNAKE VENOM: A REVIEW OF EPIDEMIOLOGY, CLINICAL MANIFESTATIONS AND TREATMENT Polianna L.M.M. ALBUQUERQUE(1,2), Camilla N. JACINTO(2), Geraldo B. SILVA JUNIOR(2,3), Juliana B. LIMA(2), Maria do Socorro B. VERAS(1) & Elizabeth F. DAHER(2) SUMMARY Ophidic accidents are an important public health problem due to their incidence, morbidity and mortality. An increasing number of cases have been registered in Brazil in the last few years. Several studies point to the importance of knowing the clinical complications and adequate approach in these accidents. However, knowledge about the risk factors is not enough and there are an increasing number of deaths due to these accidents in Brazil. In this context, acute kidney injury (AKI) appears as one of the main causes of death and consequences for these victims, which are mainly young males working in rural areas. Snakes of the Bothrops and Crotalus genera are the main responsible for renal involvement in ophidic accidents in South America. The present study is a literature review of AKI caused by Bothrops and Crotalus snake venom regarding diverse characteristics, emphasizing the most appropriate therapeutic approach for these cases. Recent studies have been carried out searching for complementary therapies for the treatment of ophidic accidents, including the use of lipoic acid, simvastatin and allopurinol. Some plants, such as Apocynaceae, Lamiaceae and Rubiaceae seem to have a beneficial role in the treatment of this type of envenomation. Future studies will certainly find new therapeutic measures for ophidic accidents. KEYWORDS: Snakebites; Ophidic accidents; Acute kidney injury; Complications. INTRODUCTION Snakes have evoked human curiosity since the ancient Egyptian civilizations and the book of Genesis shows the snake as the personification of Evil. In ancient Brazil, the lethal danger of ophidic accidents scared the Portuguese explorers. With the development of hyperimmune sera, a new phase in the study of ophidic accidents began, which is still of scientific interest to this day. Ophidic accidents are still an important problem in public health due to their high frequency and severity 3 . There are approximately three thousand known snakes’ species and 20% are venomous 34 . There are four clinically relevant venomous snakes’ genera in Latin America: Bothrops, Crotalus, Lachesis and Micrurus 34 . Snakes of the Bothrops genus are responsible for the majority of accidents, and this is partly due to their vast geographical distribution and aggressive behavior when feeling threatened 38 . Due to its high vascularity, the kidney is highly susceptible to toxins 44 . The snakes of the genus Bothrops and Crotalus can cause severe systemic reactions, and acute kidney injury (AKI) is one of the most severe complications of snakebites 2 . The knowledge of these complications by the health care professional is essential for an adequate approach of patients victims of accidents with venomous snakes. The aim of this study is to review the aspects of AKI caused by the venom of the Bothrops and Crotalus genera regarding their diverse characteristics, emphasizing the most appropriate therapeutic approach for these cases. EPIDEMIOLOGICAL ASPECTS OF OPHIDIC ACCIDENTS According to the World Health Organization (WHO), the presence of venomous snakes occurs in all the regions of the globe and is a public health problem, especially in tropical areas. Envenomation due to snakebites is considered one of the main neglected tropical diseases, affecting the poor rural populations of Africa, Asia, Latin America and Oceania 22 . The WHO estimates the occurrence of 2,500,000 snakebites per year, resulting in 125,000 deaths worldwide and approximately 100,000 survivors with severe consequences 16,34 . Latin America is the third most affected geographical area, after Africa and Asia 5,16 . In Brazil, these accidents have shown a 32.7% increase in the period between 2004 and 2009, according to data from the Ministry of Health