{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T08:13:36Z","timestamp":1777364016954,"version":"3.51.4"},"reference-count":44,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:00:00Z","timestamp":1636675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Snakebite-induced acute kidney injury (AKI) is frequently observed in patients following bites from vipers such as Russell\u2019s viper (Daboia russelii) in India. Currently, the levels of serum creatinine are mainly used as a marker to determine the necessity for renal replacement therapy (RRT) (haemodialysis) in severe cases of AKI. However, it takes up to 48 h to ascertain a distinct change in creatinine levels compared to its baseline level upon admission. The time lost between admission and the 48 h timepoint significantly affects the clinical management of snakebite victims. Moreover, early diagnosis of AKI and decision on the necessity for RRT in snakebite victims is critical in saving lives, reducing long-term complications, and minimising treatment costs arising from expensive haemodialysis. Neutrophil gelatinase\u2013associated lipocalin (NGAL) has been recently studied as a robust early marker for AKI in non-snakebite patients. However, its suitability for clinical use in snakebite victims has not been rigorously established. Here, we demonstrate the clinical significance of plasma NGAL as a robust marker for RRT following AKI using a large cohort (309) of Russell\u2019s viper victims without any pre-existing health conditions. NGAL levels upon admission are positively correlated with creatinine levels at 48 h in different stages of AKI. Overall, NGAL acts as a robust early marker to ascertain the need for RRT following Russell\u2019s viper bites. The quantification of NGAL can be recommended as a routine test in hospitals that treat snakebites to decide on RRT at early time points instead of waiting for 48 h to confirm the increase in creatinine levels. The diagnostic use of NGAL in Russell\u2019s viper victims with pre-existing comorbidities and for other vipers should be evaluated in future studies.<\/jats:p>","DOI":"10.3390\/toxins13110797","type":"journal-article","created":{"date-parts":[[2021,11,14]],"date-time":"2021-11-14T20:52:28Z","timestamp":1636923148000},"page":"797","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Neutrophil Gelatinase\u2013Associated Lipocalin Acts as a Robust Early Diagnostic Marker for Renal Replacement Therapy in Patients with Russell\u2019s Viper Bite\u2013Induced Acute Kidney Injuries"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5262-8367","authenticated-orcid":false,"given":"Subramanian","family":"Senthilkumaran","sequence":"first","affiliation":[{"name":"Department of Biotechnology, School of Biosciences, Periyar University, Salem 636011, Tamil Nadu, India"},{"name":"Emergency Department, Manian Medical Centre, Erode 638001, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ketan","family":"Patel","sequence":"additional","affiliation":[{"name":"School of Biological Sciences, University of Reading, Reading RG6 6UB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anika","family":"Salim","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of Reading, Reading RG6 6UB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pradeep","family":"Vijayakumar","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of Reading, Reading RG6 6UB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harry F.","family":"Williams","sequence":"additional","affiliation":[{"name":"Research and Development Department, Toxiven Biotech Private Limited, Coimbatore 641042, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajendran","family":"Vaiyapuri","sequence":"additional","affiliation":[{"name":"Research and Development Department, Toxiven Biotech Private Limited, Coimbatore 641042, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravi","family":"Savania","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of Reading, Reading RG6 6UB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9113-480X","authenticated-orcid":false,"given":"Namasivayam","family":"Elangovan","sequence":"additional","affiliation":[{"name":"Department of Biotechnology, School of Biosciences, Periyar University, Salem 636011, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ponniah","family":"Thirumalaikolundusubramanian","sequence":"additional","affiliation":[{"name":"Research Department, Trichy SRM Medical College Hospital & Research Centre, Trichy 621105, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. Fazil","family":"Baksh","sequence":"additional","affiliation":[{"name":"Department of Mathematics and Statistics, University of Reading, Reading RG6 6UR, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6006-6517","authenticated-orcid":false,"given":"Sakthivel","family":"Vaiyapuri","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of Reading, Reading RG6 6UB, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Kasturiratne, A., Wickremasinghe, A.R., de Silva, N., Gunawardena, N.K., Pathmeswaran, A., Premaratna, R., Savioli, L., Lalloo, D.G., and de Silva, H.J. (2008). The global burden of snakebite: A literature analysis and modelling based on regional es-timates of envenoming and deaths. 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