Thrombotic Microangiopathy and Hemolytic Uremic Syndrome Following Viperidae Snakebites in Sri Lanka

Russell’s viper and hump-nosed viper are deadly venomous Viperidae snakes in Sri Lanka. Both these vipers are widely distributed in all climatic zones of the island. Russell’s viper causes systemic envenoming such as coagulopathy, neuroparalysis and acute kidney injury (AKI) whilst hump-nosed viper frequently causes local envenoming and rarely causes AKI and coagulopathy. These two snakes may cause atypical syndromes like thrombotic microangiopathy (TMA) and hemolytic uremic syndrome (HUS). We report two cases of HUS, a type of TMA and a rare complication of snakebites including the triad of AKI, thrombocytopenia and microangiopathic hemolysis.