Two cases of acute renal failure after brown snake bite

Two patients from southern metropolitan Perth presented to Fremantle Hospital within a three week period with brown snake (genus Pseudonaja) envenomation, resulting in coagulopathy, thrombocytopaenia, anaemia and acute renal failure. Coagulopathy and thrombocytopaenia are well recognised complications of brown snake bite. However acute renal failure from brown snake bite has been described on only six previous occasions in the Australian literature, three from Western Australia in 1976. In these three cases, the genus of snake was not confirmed and the atypical envenomation syndromes suggested that other genera may have been responsible. In our patients, brown snake envenomation was confirmed with the Commonwealth Serum Laboratories Venom Detection Kit. The renal failure was self‐limiting in both cases though one patient required dialysis for 12 days. Neither patient developed rhabdomyolysis or myoglobinuria. These are the first cases of acute renal failure complicating definite brown snake envenomation reported from Western Australia. The most likely snake in both cases was the dugite (P affinis), however gwardar (P nuchalis) envenomation could not be excluded. Renal failure after brown snake bite is a rare but important complication.