Acute kidney injury complicating bee stings – a review

Abstract

Bee stings can cause severe reactions and have caused many victims in the last years. Allergic reactions can be triggered by a single sting and the greater the number of stings, the worse the prognosis. The poisoning effects can be systemic and can eventually cause death. The poison components are melitin, apamin, peptide 401, phospholipase A2, hyaluronidase, histamine, dopamine, and norepinephrine, with melitin being the main lethal component. Acute kidney injury (AKI) can be observed in patients suffering from bee stings and this is due to multiple factors, such as intravascular hemolysis, rhabdomyolysis, hypotension and direct toxicity of the venom components to the renal tubules. Arterial hypotension plays an important role in this type of AKI, leading to ischemic renal lesion. The most commonly identified biopsy finding in these cases is acute tubular necrosis, which can occur due to both, ischemic injury and the nephrotoxicity of venom components. Hemolysis and rhabdomyolysis reported in many cases in the literature, were demonstrated by elevated serum levels of indirect bilirubin and creatine kinase. The severity of AKI seems to be associated with the number of stings, since creatinine levels were higher, in most cases, when there were more than 1,000 stings. The aim of this study is to present an updated review of AKI associated with bee stings, including the currently advised clinical approach.

Comparison of Clinical Manifestations, Treatments, and Outcomes between Vespidae Sting and Formicidae Sting Patients in the Emergency Department in Taiwan

“…CK is an enzyme found in the heart, brain, skeletal muscle, and other tissues. Increased amounts of CK are associated with tissue damage [ 34 ]. We suggest that a routine check of general data would have higher values in the Vespidae group with anaphylactic reaction, but there may be no need for a routine check of general data in the Formicidae group, even with anaphylactic reaction.…”

Acute kidney injury in a Tanzanian boy following multiple bee stings in resource-limited setting: a case report

“…Bee sting can cause severe anaphylaxis reaction and arterial hypotension which might lead to significant damage and even death. This is a major component that cause AKI due to ischemia of the renal tubules [ 5 ]. The protein components in bee venom, phospholipase A2, hyaluronic acid, melittin and apamin are culprits.…”

“…The other mechanism is when there is rhabdomyolysis, the myoglobin are toxic to the renal tubule [ 5 , 6 , 10 , 11 ]. Bee sting venom is thought to cause non traumatic rhabdomyolysis.…”

“…Both hemodialysis and peritoneal dialysis have been used to treat AKI following multiple bee sting effectively with good outcomes [ 2 , 4 , 5 , 8 , 9 , 11 ]. Although dialysis does not clear the bee venom, maintenance of good hydration and urine output are necessary in management of bee sting venom.…”

“…The complication of the stings ranges from local reaction (skin reaction) to anaphylaxis and multiple organ failure(systemic sting reaction). Evenomation by bee sting of >500 are sufficient to cause significant damage and even death [ 2 , 4 , 5 ]. Bee sting triggers immediate allergic reaction mediated by Immunoglobin E with large local reaction such as urticaria, flushing and angioedema while hypotension, dyspnea and dizziness can progress to loss of consciousness, shock and even cardiopulmonary arrest.…”