Lesión renal aguda secundaria al envenenamiento de Lonomia. Informe de casos y revisión de literatura
Publicado
abr 2, 2020
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Daniel Martin Arsanios
https://orcid.org/0000-0003-1293-3759
Elias Quintero
Nicolás David Santoyo Sarmiento
Alvaro German Arteaga Erazo
Maria José Olaya
Alejandra Perilla
Alirio Bastidas Goyes
https://orcid.org/0000-0003-1293-3759
Elias Quintero
Nicolás David Santoyo Sarmiento
Alvaro German Arteaga Erazo
Maria José Olaya
Alejandra Perilla
Alirio Bastidas Goyes
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Resumen
Resumen
Introducción
El envenenamiento por especies de Lonomia se produce principalmente en las zonas rurales. El síntoma principal de esta afección es hemorragia y una alteración en los tiempos de coagulación. Sin embargo, la lesión renal aguda también se ha identificado en algunos informes de casos. Por lo tanto, no debe ser ignorado y para entender el mecanismo fisiopatológico, diagnóstico y tratamiento de esta característica clínica resulta necesario ampliar la conciencia y prevenir más complicaciones médicas y la muerte.
Materiales y métodos
Presentamos un informe de caso y una revisión de la literatura para caracterizar a pacientes con lesión renal aguda secundaria al envenenamiento de Lonomia por medio de la descripción de la fisiopatología, diagnóstico, tratamiento y pronóstico de pacientes que sufren de esta afección. La información se obtuvo de 4 bases de datos: Medline, Embase, LILACs y Ovid. Usamos la siguiente estrategia de búsqueda: ((("Lesión renal aguda" [Malla]) Y "lonofibrase" [Concepto suplementario]) O accidente de lonómico) O accidente de lonomia.
Resultados
Identificamos diez informes de casos de envenenamiento por Lonomia spp., nueve de ellos fueron causados por L. obliqua y uno por L. achelous. También se incluyó un estudio de cohorte que incluyó a 37 pacientes que estuvieron expuestos al veneno de L. obliqua. Todos los pacientes eran adultos, vivían en el campo y desarrollaban lesión renal aguda.
Conclusiones
La lesión renal aguda se ha identificado como una característica clínica importante del envenenamiento por Lonomia. El desarrollo de esta condición está mediado por varios mecanismos fisiopatológicos. Para realizar un diagnóstico adecuado, se deben realizar tiempos de coagulación, niveles de fibrinógeno, hemograma, función renal y análisis de orina. El tratamiento definitivo depende del tipo de envenenamiento. El pronóstico para estos pacientes aún no está bien descrito. Sin embargo, nuestro paciente tuvo una buena respuesta a la administración descrita dada.
Keywords
References
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13. Chudzinski-Tavassi AM, Schattner M, Fritzen M, Pozner RG, Reis CV, Lourenço D, et al. Effects of lopap on human endothelial cells and platelets. Pathophysiol Haemost Thromb [Internet]. 2001 [cited 2018 Sep 30];31(3–6):257–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11910193
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18. Zager RA, Johnson ACM, Becker K. Renal cortical hemopexin accumulation in response to acute kidney injury. Am J Physiol Physiol [Internet]. 2012 Nov 15 [cited 2018 Nov 25];303(10):F1460–72. Available from: http://www.physiology.org/doi/10.1152/ajprenal.00426.2012
19. Berger M, Ribeiro Vieira MA, Almeida J. Acute kidney injury induced by snake and arthropod venoms. In: Renal failure: the facts. InTech; 2012.
20. Seibert CS, Tanaka-Azevedo AM, Santoro ML, Mackessy SP, Soares Torquato RJ, Lebrun I, et al. Purification of a phospholipase A2 from Lonomia obliqua caterpillar bristle extract. Biochem Biophys Res Commun [Internet]. 2006 Apr 21 [cited 2018 Nov 25];342(4):1027–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16510123
21. Linardi A, Rocha e Silva TAA, Miyabara EH, Franco-Penteado CF, Cardoso KC, Boer PA, et al. Histological and functional renal alterations caused by Bothrops alternatus snake venom: Expression and activity of Na+/K+-ATPase. Biochim Biophys Acta - Gen Subj [Internet]. 2011 Sep [cited 2018 Nov 25];1810(9):895–906. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0304416511001334
22. Bohrer CB, Reck Junior J, Fernandes D, Sordi R, Guimarães JA, Assreuy J, et al. Kallikrein-kinin system activation by Lonomia obliqua caterpillar bristles: involvement in edema and hypotension responses to envenomation. Toxicon. 2007 Apr;49(5):663–9.
23. Zannin M, Lourenço DM, Motta G, Dalla Costa LR, Grando M, Gamborgi GP, et al. Blood coagulation and fibrinolytic factors in 105 patients with hemorrhagic syndrome caused by accidental contact with Lonomia obliqua caterpillar in Santa Catarina, southern Brazil. Thromb Haemost [Internet]. 2003 Feb [cited 2018 Sep 21];89(2):355–64. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12574817
24. Nascimento-Silva V, Rodrigues da Silva G, Moraes JA, Cyrino FZ, Seabra SH, Bouskela E, et al. A pro-inflammatory profile of endothelial cell in Lonomia obliqua envenomation. Toxicon [Internet]. 2012 Jul [cited 2018 Mar 19];60(1):50–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22779081
25. Barrios M, Taylor P, Rodríguez-Acosta A, Sánchez EE, Arocha-Piñango CL, Gil A, et al. A mouse model to study the alterations in haemostatic and inflammatory parameters induced by Lonomia achelous caterpillar haemolymph. Toxicon [Internet]. 2012 Apr [cited 2018 Mar 19];59(5):547–54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22310207
26. Moraes J, Rodrigues G, Nascimento-Silva V, Renovato-Martins M, Berger M, Guimarães J, et al. Effects of Lonomia obliqua venom on vascular smooth muscle cells: contribution of NADPH oxidase-derived reactive oxygen species. Toxins (Basel) [Internet]. 2017 Nov 7 [cited 2018 Nov 25];9(11):360. Available from: http://www.mdpi.com/2072-6651/9/11/360
27. Pawluczyk IZ, Harris KP. Cytokine interactions promote synergistic fibronectin accumulation by mesangial cells. Kidney Int [Internet]. 1998 Jul 1 [cited 2018 Nov 25];54(1):62–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9648064
28. Veiga ABG, Pinto AFM, Guimarães JA. Fibrinogenolytic and procoagulant activities in the hemorrhagic syndrome caused by Lonomia obliqua caterpillars. Thromb Res [Internet]. 2003 [cited 2018 Sep 30];111(1–2):95–101. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14644086
29. Carrijo-Carvalho LC, Chudzinski-Tavassi AM. The venom of the Lonomia caterpillar: An overview. Toxicon [Internet]. 2007 May [cited 2018 Sep 30];49(6):741–57. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17320134
30. Maggi S, Faulhaber GAM, Maggi S, Faulhaber GAM. Lonomia obliqua Walker (Lepidoptera: Saturniidae): hemostasis implications. Rev Assoc Med Bras [Internet]. 2015 Jun [cited 2018 Mar 19];61(3):263–8. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302015000300263&lng=en&tlng=en
31. Coll-Sangrona E, Arocha-Piñango CL. Fibrinolytic action on fresh human clots of whole body extracts and two semipurified fractions from Lonomia achelous caterpillar. Brazilian J Med Biol Res. 1998;31(6):779–84.
32. Alvarez Flores MP, Fritzen M, Chudzinski-Tavassi AM. Effects of LOSAC (a Factor X activator from Lonomia oblique caterpillar) on HUVECs and sequencing. Paper proceedings of Congresso da Sociedade Brasileira de Toxinologia, Andra dos Reis; 2004.
33. Fritzen M, Alvarez Flores MP, Reis CV, Chudzinski-Tavassi AM. A prothrombin activator (Lopap) modulating inflammation, coagulation and cell survival mechanisms. Biochem Biophys Res Commun [Internet]. 2005 Jul 29 [cited 2018 Mar 19];333(2):517–23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15963468
34. Fritzen M, Schattner M, Quintana Ribeiro AL, de Fátima Correia Batista I, Ventura J, Prezoto BC, et al. Lonomia obliqua venom action on fibrinolytic system. Thromb Res [Internet]. 2003 Jan [cited 2018 Sep 30];112(1–2):105–10. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0049384803005863
35. Bastos L de C, Veiga ABG, Guimarães JA, Tonussi CR. Nociceptive and edematogenic responses elicited by a crude bristle extract of Lonomia obliqua caterpillars. Toxicon [Internet]. 2004 Mar 1 [cited 2018 Sep 30];43(3):273–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15033325
36. Burdmann EA, Antunes I, Saldanha LB, Abdulkader RC. Severe acute renal failure induced by the venom of Lonomia caterpillars. Clin Nephrol [Internet]. 1996 Nov [cited 2018 Sep 30];46(5):337–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8953124
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2. Riella MC, Chula D, de Freitas S, Mazza MM, Pachaly MA. Acute renal failure and haemorrhagic syndrome secondary to toxin of caterpillars (Lonomia obliqua). Clin Kidney J [Internet]. 2008 Dec 1 [cited 2018 Nov 25];1(6):445–6. Available from: https://academic.oup.com/ckj/article-lookup/doi/10.1093/ndtplus/sfn138
3. Gamborgi GP, Metcalf EB, Barros EJ. Acute renal failure provoked by toxin from caterpillars of the species Lonomia obliqua. Toxicon [Internet]. 2006 Jan [cited 2018 Sep 21];47(1):68–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16310819
4. Arocha-Piñango CL, Guerrero B. Lonomia obliqua and haemorrhagic syndrome. Lancet. 1999; 354:1304. Available from: https://www.ncbi.nlm.nih.gov/pubmed/1052066646
5. Khwaja A. KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Nephron. 2012 Aug;120(4):c179–84.
6. Alvarez Flores MP, Zannin M, Chudzinski-Tavassi AM. New insight into the mechanism of Lonomia obliqua envenoming: toxin involvement and molecular approach. Pathophysiol Haemost Thromb [Internet]. 2010 [cited 2018 Sep 30];37(1):1–16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2071412642
7. Ávila A, Moreno A, Garzón A, Gómez A. Accidente lonómico Lonomiasis. Acta Médica Colomb. 2013;38:95–100.
8. Sarmiento NS, Arsanios DM, Quintero Muñoz E, Santoyo Sarmiento C. Lonomic accident and allergic reaction to anti-lonomic serum: case report and literature review [Internet]. 2018 [cited 2018 Sep 13]. Available from: http://www.ijcrls.com
9. Berger M, Santi L, Beys-da-Silva WO, Oliveira FMS, Caliari MV, Yates JR, et al. Mechanisms of acute kidney injury induced by experimental Lonomia obliqua envenomation. Arch Toxicol [Internet]. 2015 Mar 6 [cited 2018 Sep 30];89(3):459–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24798088
10. Schmitberger P, Fernandes T, Santos R, de Assis R, Gomes A, Siqueira P, et al. Probable chronic renal failure caused by Lonomia caterpillar envenomation. J Venom Anim Toxins Incl Trop Dis [Internet]. 2013 Jun 3 [cited 2019 Apr 7];19(1):14. Available from: http://jvat.biomedcentral.com/articles/10.1186/1678-9199-19-14
11. Da Silva WD, Rocha Campos ACM, Gonçalves LRC, Sousa-E-Silva MCC, G. Higashi H, K. Yamagushi I, et al. Development of an antivenom against toxins of Lonomia obliqua caterpillars. Toxicon [Internet]. 1996;34(9):1045–9. Available from: http://www.sciencedirect.com/science/article/pii/0041010196000529
12. Sano-Martins IS, Duarte AC, Guerrero B, Moraes RHP, Barros EJG, Arocha-Piñango CL. Hemostatic disorders induced by skin contact with Lonomia obliqua (Lepidoptera, Saturniidae) caterpillars. Rev Inst Med Trop Sao Paulo [Internet]. 2017 Apr 20 [cited 2018 Mar 19];59:e24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28443942
13. Chudzinski-Tavassi AM, Schattner M, Fritzen M, Pozner RG, Reis CV, Lourenço D, et al. Effects of lopap on human endothelial cells and platelets. Pathophysiol Haemost Thromb [Internet]. 2001 [cited 2018 Sep 30];31(3–6):257–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11910193
14. Berger M et al. Renal and vascular effects of kallikrein inhibition in a model of Lonomia obliqua venom-induced acute kidney injury. PLOS Negl Trop Dis. 2019;13(2). https://doi.org/10.1371/journal.pntd.0007197
15. Sano-Martins I, Gonzalez C. Effectiveness of Lonomia antivenom in recovery from the coagulopathy induced by Lonomia orientoandensis and Lonomia casanarensis caterpillars in rats. PLOS Neglected Tropical Diseases. August 16, 2018. Available from: https://doi.org/10.1371/journal.pntd.0006721
16. Pinto AFM, Berger M, Reck J, Terra RMS, Guimarães JA. Lonomia obliqua venom: In vivo effects and molecular aspects associated with the hemorrhagic syndrome. Toxicon [Internet]. 2010 Dec [cited 2018 Sep 21];56(7):1103–12. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0041010110000279
17. Berger M, Beys-da-Silva WO, Santi L, de Oliveira IM, Jorge PM, Henriques JAÔP, et al. Acute Lonomia obliqua caterpillar envenomation-induced physiopathological alterations in rats: Evidence of new toxic venom activities and the efficacy of serum therapy to counteract systemic tissue damage. Toxicon [Internet]. 2013;74:179–92. Available from: http://dx.doi.org/10.1016/j.toxicon.2013.08.061
18. Zager RA, Johnson ACM, Becker K. Renal cortical hemopexin accumulation in response to acute kidney injury. Am J Physiol Physiol [Internet]. 2012 Nov 15 [cited 2018 Nov 25];303(10):F1460–72. Available from: http://www.physiology.org/doi/10.1152/ajprenal.00426.2012
19. Berger M, Ribeiro Vieira MA, Almeida J. Acute kidney injury induced by snake and arthropod venoms. In: Renal failure: the facts. InTech; 2012.
20. Seibert CS, Tanaka-Azevedo AM, Santoro ML, Mackessy SP, Soares Torquato RJ, Lebrun I, et al. Purification of a phospholipase A2 from Lonomia obliqua caterpillar bristle extract. Biochem Biophys Res Commun [Internet]. 2006 Apr 21 [cited 2018 Nov 25];342(4):1027–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16510123
21. Linardi A, Rocha e Silva TAA, Miyabara EH, Franco-Penteado CF, Cardoso KC, Boer PA, et al. Histological and functional renal alterations caused by Bothrops alternatus snake venom: Expression and activity of Na+/K+-ATPase. Biochim Biophys Acta - Gen Subj [Internet]. 2011 Sep [cited 2018 Nov 25];1810(9):895–906. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0304416511001334
22. Bohrer CB, Reck Junior J, Fernandes D, Sordi R, Guimarães JA, Assreuy J, et al. Kallikrein-kinin system activation by Lonomia obliqua caterpillar bristles: involvement in edema and hypotension responses to envenomation. Toxicon. 2007 Apr;49(5):663–9.
23. Zannin M, Lourenço DM, Motta G, Dalla Costa LR, Grando M, Gamborgi GP, et al. Blood coagulation and fibrinolytic factors in 105 patients with hemorrhagic syndrome caused by accidental contact with Lonomia obliqua caterpillar in Santa Catarina, southern Brazil. Thromb Haemost [Internet]. 2003 Feb [cited 2018 Sep 21];89(2):355–64. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12574817
24. Nascimento-Silva V, Rodrigues da Silva G, Moraes JA, Cyrino FZ, Seabra SH, Bouskela E, et al. A pro-inflammatory profile of endothelial cell in Lonomia obliqua envenomation. Toxicon [Internet]. 2012 Jul [cited 2018 Mar 19];60(1):50–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22779081
25. Barrios M, Taylor P, Rodríguez-Acosta A, Sánchez EE, Arocha-Piñango CL, Gil A, et al. A mouse model to study the alterations in haemostatic and inflammatory parameters induced by Lonomia achelous caterpillar haemolymph. Toxicon [Internet]. 2012 Apr [cited 2018 Mar 19];59(5):547–54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22310207
26. Moraes J, Rodrigues G, Nascimento-Silva V, Renovato-Martins M, Berger M, Guimarães J, et al. Effects of Lonomia obliqua venom on vascular smooth muscle cells: contribution of NADPH oxidase-derived reactive oxygen species. Toxins (Basel) [Internet]. 2017 Nov 7 [cited 2018 Nov 25];9(11):360. Available from: http://www.mdpi.com/2072-6651/9/11/360
27. Pawluczyk IZ, Harris KP. Cytokine interactions promote synergistic fibronectin accumulation by mesangial cells. Kidney Int [Internet]. 1998 Jul 1 [cited 2018 Nov 25];54(1):62–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9648064
28. Veiga ABG, Pinto AFM, Guimarães JA. Fibrinogenolytic and procoagulant activities in the hemorrhagic syndrome caused by Lonomia obliqua caterpillars. Thromb Res [Internet]. 2003 [cited 2018 Sep 30];111(1–2):95–101. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14644086
29. Carrijo-Carvalho LC, Chudzinski-Tavassi AM. The venom of the Lonomia caterpillar: An overview. Toxicon [Internet]. 2007 May [cited 2018 Sep 30];49(6):741–57. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17320134
30. Maggi S, Faulhaber GAM, Maggi S, Faulhaber GAM. Lonomia obliqua Walker (Lepidoptera: Saturniidae): hemostasis implications. Rev Assoc Med Bras [Internet]. 2015 Jun [cited 2018 Mar 19];61(3):263–8. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302015000300263&lng=en&tlng=en
31. Coll-Sangrona E, Arocha-Piñango CL. Fibrinolytic action on fresh human clots of whole body extracts and two semipurified fractions from Lonomia achelous caterpillar. Brazilian J Med Biol Res. 1998;31(6):779–84.
32. Alvarez Flores MP, Fritzen M, Chudzinski-Tavassi AM. Effects of LOSAC (a Factor X activator from Lonomia oblique caterpillar) on HUVECs and sequencing. Paper proceedings of Congresso da Sociedade Brasileira de Toxinologia, Andra dos Reis; 2004.
33. Fritzen M, Alvarez Flores MP, Reis CV, Chudzinski-Tavassi AM. A prothrombin activator (Lopap) modulating inflammation, coagulation and cell survival mechanisms. Biochem Biophys Res Commun [Internet]. 2005 Jul 29 [cited 2018 Mar 19];333(2):517–23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15963468
34. Fritzen M, Schattner M, Quintana Ribeiro AL, de Fátima Correia Batista I, Ventura J, Prezoto BC, et al. Lonomia obliqua venom action on fibrinolytic system. Thromb Res [Internet]. 2003 Jan [cited 2018 Sep 30];112(1–2):105–10. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0049384803005863
35. Bastos L de C, Veiga ABG, Guimarães JA, Tonussi CR. Nociceptive and edematogenic responses elicited by a crude bristle extract of Lonomia obliqua caterpillars. Toxicon [Internet]. 2004 Mar 1 [cited 2018 Sep 30];43(3):273–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15033325
36. Burdmann EA, Antunes I, Saldanha LB, Abdulkader RC. Severe acute renal failure induced by the venom of Lonomia caterpillars. Clin Nephrol [Internet]. 1996 Nov [cited 2018 Sep 30];46(5):337–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8953124
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Cómo citar
Martin Arsanios, D., Quintero, E., Santoyo Sarmiento, N. D., Arteaga Erazo, A. G., Olaya, M. J., Perilla, A., & Bastidas Goyes, A. (2020). Lesión renal aguda secundaria al envenenamiento de Lonomia. Informe de casos y revisión de literatura. Universitas Medica, 61(2). https://doi.org/10.11144/Javeriana.umed61-2.lono
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