Pathophysiological effects of Russell's viper venom on renal function

Pathophysiological effects of Russell's viper venom (RVV) on renal function are reviewed. The evidence in experimental animals on the mechanisms of venom action in relation to changes in either extrarenal or intrarenal factors is considered. The cardiovascular system and renal hemodynamics are affected by the venom. Mean arterial blood pressure, heart rate, cardiac output, and renal hemodynamics decrease, while total peripheral vascular resistance and renal vascular resistance increase in the initial post-injection period of envenoming. After the transitory decrease, all parameters for general circulation gradually increase, returning to near normal level within 30 min, while an increase in renal vascular resistance and decreases in renal blood flow and glomerular filtration rate are still apparent 48 h after envenomation. The effects of venom on renal vasoconstriction are discussed. Possible factors, especially humoral factors, inducing these changes are considered. Russell's viper venom is also able to affect renal tubular cells directly. This can be explained based on available data from in vitro studies. Different studies have been performed to investigate venom action in the isolated perfused kidney, changes in the characteristic polarization of the cell membrane, changes in mitochondria activity and changes in Na, K-ATPase activity of the tissue of both the renal cortex and medulla during envenomation.