Acute renal failure following multiple hornet stings

Abstract

Hornet stings are medically important stings which can cause allergic manifestations and, in severe cases, may lead to the unusual complication of acute renal failure (ARF) and other systemic complications. ARF results from toxic or ischaemic acute tubular necrosis in a setting of haemolysis or rhabdomyolysis or both and acute allergic interstitial nephritis. Venom from hornet stings can also contribute to myocardial injury or liver impairment. Here, we report three cases of hornet stings leading to ARF. Case #1 and Case #3 recovered their renal function and body physiology after a 38-day and 15-day stay in the hospital, respectively, whereas Case #2 died. They were meticulously supported by haemodialysis along with the combination of various drug regimens.

Pharmacological and Immunological Properties of Wasp Venom

“…The stinging incidents are high during late summer and early fall with the numbers reaching a peak in August. [5] Various environmental factors such as temperature, humidity, solar radiation, rainfall and wind speed influences the wasp activity. Activities occurred at all temperatures above 7˚C and below 41˚C with maximum activity occurring between 20 -35˚C.…”

“…The clinical manifestations for such toxic effects include intravascular Haemolysis, rhabdomyolysis, pigment nephropathy, renal impairment, acute kidney injury, liver impairment, disseminated intravascular coagulopathy, central nervous system damage and direct toxicity to multiple organ system. [5,10,60]…”

“…A wide range of clinical sequelae is observed during wasp stings-from simple allergic skin manifestations to severe systemic reactions and toxic reactions leading to death. [5] Wasps, being highly diverse insects, are solitary or social, parasitic or predatory, phytophagous or carnivorous or omnivorous.…”

Hymenoptera Stings and the Acute Kidney Injury

“…The venom intoxication has variable effects in individuals depending upon the sensitivity of the person towards the venom and the amount of venom injected into the body. The reactions to vespid stings have been categorised as normal local reactions, large local reactions, graded systemic reactions, 27 systemic toxic reactions 12,30 and unusual reactions. 31,32 The most common clinical pattern of the Hymenoptera stings are the local reactions that resolve within a few hours or large local reactions that last longer than 24 hours, or the systemic reactions grade I-IV.…”

“…4 A wide range of clinical sequelae involving multiple organ systems is observed during massive envenomation. [8][9][10][11][12] As a highly vascularised and excretory organ, the kidney is particularly vulnerable to Hymenoptera toxins. 3 In this review, we restrict our discussion to the immunemediated and toxic effect of the vespid and the apid venom, with an emphasis on renal involvement.…”