Nephrotic syndrome after insect sting: a case report

Abstract

Minimal change disease accounts for up to 25% of the cases of nephrotic syndrome in adult population. The allergic mechanism has been associated with minimal change disease and allergens have been implied, namely insect stings. We present a case report of a woman with new onset of nephrotic syndrome after a non-hymenoptera insect sting, with biopsy-proven minimal change disease, that was accompanied by a pulmonary thromboembolism process. Complete remission with glucocorticoid therapy was observed, with sustained response for 6 months after discontinuation. A new exposure to insect sting in the same geographical region and season triggered a nephrotic syndrome relapse. Subsequent avoidance of the place resulted in a sustained remission for more than 4 years.

Relapsing nephrotic syndrome with acute renal failure following a unique episode of multiple bee stings: A case report

“…Pure NS 15 , 16 , 17 , 18 or AKI, 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 a few rhabdomyolysis‐related, can be complications of bee stings but often described as separate clinical presentations and lasting for a limited period. This is an exceptional case that encompasses NS and AKI following this very unusual trigger, that we compared with a few published reports, described in Table 1 .…”

“…For those cases the renal involvement is usually an acute kidney injury (AKI) 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 in isolated reports related to rhabdomyolysis 13 , 14 or other toxicities of bee venom, with very rare cases of nephrotic syndrome (NS). 15 , 16 , 17 , 18 The combination of these two forms of kidney injury due to honeybee stings is extremely rare, 19 , 20 , 21 , 22 , 23 even more so if they are a consequence of stings from “non‐Africanised” bees. Herein, we present a case of NS with AKI secondary to multiple European honeybee stings, where a renal biopsy demonstrated a minimal change disease (MCD) with acute tubulo‐necrosis (ATN) disease.…”

“…These severe reactions to honeybee stings are mainly associated with massive attacks from “Africanised” bees ( Apis mellifera adansonii ; Apis mellifera scutellata ), which have been artificially introduced in several countries for commercial purposes. For those cases the renal involvement is usually an acute kidney injury (AKI) 5–12 in isolated reports related to rhabdomyolysis 13,14 or other toxicities of bee venom, with very rare cases of nephrotic syndrome (NS) 15–18 . The combination of these two forms of kidney injury due to honeybee stings is extremely rare, 19–23 even more so if they are a consequence of stings from “non‐Africanised” bees.…”