Kidney damage is frequently encountered in the victims of snakebites (particularly from vipers) and delayed treatment often results in deaths. Currently, the diagnosis of snakebite-induced kidney damage is not easy, as the symptoms take up to 48 hours to appear, and essential treatment is delayed. This can result in complications which increase the treatment costs. In this study, we identified an early biomarker which can confirm kidney damage within an hour, so that doctors can initiate immediate treatment to alleviate serious complications and reduce the treatment costs.   

Russell’s viper. Image: Dfpindia, CC BY-SA 4.0 via Wikimedia Commons

Snakebite is a high-priority yet neglected public health issue in many tropical and subtropical countries. Venomous snakebites cause numerous complications including excessive bleeding, clotting disorders and kidney damage, often leading to permanent disabilities or deaths. Our work explored the use of a biomarker to assist in early detection of snakebite-induced kidney damage, with the potential to improve patient outcomes as well as significantly reduce the cost of treatment.

India has some of the highest snakebite cases in the world, with approximately 58,000 deaths per year. With around 62 known venomous snake species, the most medically important snakes, known as the ‘Big Four’ (Russell’s viper, Indian cobra, Krait, and Saw-scaled viper), are responsible for the most bites. Notably, Russell’s viper is responsible for a majority of snakebite incidents and related deaths and disabilities in rural India.

Rapid deterioration of kidney function following Russell’s viper bites is frequently observed in victims. Acute kidney injury (AKI) is one of the key factors that contribute to deaths and long-term complications. Moreover, patients with AKI who end up requiring renal replacement therapy (dialysis) are left with a massive burden of costs due to the substantial expense of that dialysis. Earlier clinical intervention for AKI in snakebite victims can help ensure appropriate treatment to enhance their outcomes.

Working with clinicians who treat snakebites regularly in a snakebite referral hospital (Manian Medical Centre, Tamil Nadu) and researchers in a biotech company (Toxiven Biotech), our research involving a large cohort of (309) Russell’s viper bite victims in India highlighted the use of a protein molecule, Neutrophil Gelatinase–Associated Lipocalin, as a promising and robust early diagnostic marker for Russell’s viper bite-induced AKI. Early detection of AKI using this molecule that occurs naturally upon initial kidney damage, aids in providing early treatment to prevent further renal damage and improve patient outcomes. The outcomes of this study will guide the treatment for Russell’s viper bite-induced AKI in diverse clinical settings, and further research to determine the use of this molecule for other snakes worldwide.


Anika Salim is a postgraduate research student within Professor Sakthi Vaiyapuri’s research group in Pharmacy. She recently won the University’s Research Output Prize for her article with joint first author status: ‘Neutrophil Gelatinase-Associated Lipocalin Acts as a Robust Early Diagnostic Marker for Renal Replacement Therapy in Patients with Russell’s Viper Bite-Induced Acute Kidney Injuries’, S. Senthilkumaran, K. Patel, A. Salim, P. Vijayakumar, H.F. Williams, R. Vaiyapuri, R. Savania, N. Elangovan, P. Thirumalaikolundu-subramanian, M.F. Baksh and S. Vaiyapuri Toxins (Basel). 2021 Nov 12;13(11):797. doi: 10.3390/toxins13110797. PMID: 34822581; PMCID: PMC8620021