jiafm, 2010-32(2) april-june. - forensic medicine

ISSN 0971-0973 J Indian Acad Forensic Med, 32(2)Original research paperPattern of Renal Pathology in Fatal Envenomation by Indian Cobra(Naja naja)*Dr. Partha Pratim Mukhopadhyay M.D., Ph.D., **Dr.Sulekha Ghosh D.C.P, M.D., ***Dr.T. K.Ghosh, D.C.P.AbstractDeaths due to poisonous snakebite are a significant health related problem especially the rural heartland ofin tropical countries. Renal involvement in snakebite is well documented especially so in bites by the Viperidaegroup. The Elapidae family consisting of cobra and kraits among other varieties are mainly considered neurotoxic.The venom of neurotoxic variety predominantly has direct depressing action on the respiratory center andneuromuscular junction. We investigated the renal changes at autopsy and histology of fatal cobra bites.This series included autopsy examination of 14 cases of fatal cobra bite in our hospital-based study.Dissected kidneys were sectioned, stained with hematoxylin & eosin stain and histological examination was doneunder light microscope. Five cases from head injury subject were used as control. The study reveals renalinvolvement in 64.28 %of fatal bites by Indian cobra (Naja naja) primarily considered neurotoxic. The major renalchanges were tubular necrosis 1(7.14%), cortical necrosis 3 (21.42%) and interstitial nephritis 3(21.42%). This factis worth giving due consideration during management and monitoring of cases of envenomation by cobra.Key Words: Snake Bite, Renal Pathology, Indian Cobra, Cortical Necrosis, Glomerulopathy, AutopsyIntroduction:Death due to poisonous snakebite is asignificant health related problem especially in therural heartland of South Asian countries. [1, 2] Theincidence of renal failure in poisonous snakebitevaries from 13% to 22%. [3, 4] Renal involvement insnakebite is well documented. [5, 6, 7] Bites by theViperidae group are the main cause of renal failure.[8, 9] The Elapidae family consisting of cobra andkraits among other varieties are mainly consideredneurotoxic.For clinical convenience poisonous snakesare broadly grouped into haemotoxic (Vipers) andneurotoxic (Cobra and Kraits). [10] The venom ofneurotoxic variety predominantly has directdepressing action on the respiratory center andneuromuscular junction. Snake venom contains theenzymes and non –enzyme proteins that mediate thetissue reactions. The treatment however involvescommonly polyvalent anti-serum. The present workwas designed to examine the incidence, pattern andspectrum of renal lesion in snakebite by Indian cobra(Naja naja) from the autopsy sample.Corresponding Author:Dr. Partha Pratim Mukhopadhyay*Associate ProfessorDepartment of Forensic and State MedicineBurdwan Medical College, Burdwan, West Bengal,India, PIN -713104Email: drpartha99md@gmail.com**Associate Professor, Department Of Pathology***Demonstrator, Department of PathologyMaterials and Methods:In India snakebites are unnatural deaths thatneed to be examined at autopsy (medico-legal)according to statutory rules. The series includedautopsy examination of 14 cases of fatal cobra bite inour hospital-based study. All the cases were from thesurrounding area under the jurisdiction of the localpolice administration. The sample consisted of allfatal cobra bite cases examined at complete forensicautopsy by the first author in 2009 during his routinemedico legal postmortem work The cases included allknown deaths due to cobra bite. The subjects werefrom those admitted to the hospital and receivedtreatment at Emergency ward.The snake type was retrieved from records, policeinquest, history or the offending snake captured/killed and examined. Unknown bites were excluded.Brought dead subjects with history of snakebite werealso excluded from the study. Autopsy wasconcluded within six hours of death. Any case withovert local necrotic changes and evidence ofcouagulopathy were summarily excluded.At complete autopsy all findings wererecorded in a standard protocol.Only themorphological changes in the kidneys wereconsidered for the present study. Dimensions andweight of the kidneys were recorded. Macroscopicand microscopic studies were done.Dissected kidneyswere sectioned, stained with hematoxylin & eosinstain and histological examination was done underlight microscope. Five cases from head injury subjectwere used as control.132