Table 1.
Patient demographic and clinical data.
Fig 1.
Flow chart of patient inclusion and acute kidney injury grading.
Thirty three patients who did not have two or more serum samples, one or more urine samples and at least one follow up (FU) serum sample available were excluded. One patient who had a serum creatinine value >2 mg/dl even at the follow up (FU) was excluded from the study as it is above the level of normal healthy adult.
Fig 2.
Scatter plots of the pre-antivenom Russell’s viper venom concentrations (median and interquartile range) for each of the acute injury groups.
Fig 3.
Maximum renal biomarker concentrations within 24 hours of bite.
Scatter plots of the maximum biomarker concentrations reached within 24 h post-bite for patients with no acute kidney injury (No AKI; green), mild AKI (grade 1; blue), moderate AKI (grade 2; orange) and severe AKI (grade 3; red), for serum creatinine (sCr; Panel A), serum cystatin C (sCysC; Panel B), urinary clusterin (uClu; Panel C), urinary neutrophil gelatinase-associated lipocalin (uNGAL; Panel D), kidney injury molecule-1 (uKIM-1; Panel E),albumin (uAlb; Panel F),beta2-microglobulin (uβ2M; Panel G), urinary cystatin C (uCysC; Panel H), osteopontin(uOPN; Panel I) and trefoil factor-3 (uTFF3; Panel J).
Fig 4.
Time course of the median biomarker concentrations (with interquartile ranges) for each of the three patient groups (No acute kidney injury [No AKI; green], mild AKI [blue] and moderate to severe AKI [red]). AKI, AKIN stage 1 and AKIN stage 2/3) post-bite for 2 days, then at 1 and 3 months, including serum creatinine (sCr; Panel A), serum cystatin C (sCysC; Panel B), urinary clusterin (uClu; Panel C) and urinary neutrophil gelatinase-associated lipocalin (uNGAL; Panel D). The grey shaded area is the normal range based on respective biomarkers measured in healthy individuals.
Fig 5.
Plots of the AUC-ROCs versus time for the best functional and structural biomarkers in detecting moderate/severe AKI versus No AKI/mild AKI, includingserum creatinine (sCr; Panel A), serum cystatin C (sCysC; Panel B), urinary clusterin (uClu; Panel C) and urinary neutrophil gelatinase-associated lipocalin (uNGAL; Panel D).The dark black line represents the AUC-ROCs and the shaded area covers the 95% confidence intervals (CI) for the AUC-ROC.
Table 2.
The area under the curve of the receiver operator characteristic (AUC-ROC) curve (with 95% confidence intervals) for biomarker concentrations predicting moderate to severe acute kidney injury (AKI) versus none or mild AKI, in each of the four time periods within the first 24h of the bite.