Histopathological Changes in Kidneys in Fatal Envenomation of Snake Bites

Renal toxicity is a frequent and often fatal complication of snake envenomation. This cross-sectional study aimed to characterize the renal pathological changes in 47 fatal snakebite cases subjected to autopsy at the Institute of Forensic Medicine, Madras Medical College, between 2017 and 2019. Kidney tissues were collected, processed, and H&E-stained for light microscopic examination. The analysis revealed that renal congestion was the most prevalent finding, occurring in 41 cases (87.23%), followed closely by acute tubular necrosis (ATN) in 35 cases (74.46%). Other significant observations included glomerular inflammation in 12 cases and renal cortical necrosis in one instance. These results demonstrate that snakebite nephropathy encompasses a diverse spectrum of pathological alterations, primarily driven by direct venom toxicity and secondary hemodynamic changes. Understanding these specific renal manifestations—ranging from interstitial nephritis to irreversible cortical necrosis—is essential for clinicians in managing acute kidney injury and for forensic experts in framing precise medico-legal opinions regarding the cause of death in envenomation cases.