Macroscopic hematuria in wasp sting patients: a retrospective study

Abstract

Background: Macroscopic hematuria after wasp sting has been reported in Asia to occur before acute kidney injury (AKI), and is often used by clinicians as a sign indicating the need for intensive care and blood purification therapy. However, there is no study on the clinical characteristics and prognosis of this symptom. Methods: The clinical data of 363 patients with wasp sting admitted to Suining Central Hospital from January 2016 to December 2018 were retrospectively analyzed. At admission, the poisoning severity score (PSS) was used as the criterion for severity classification. According to the presence of macroscopic hematuria, the patients were divided into macroscopic hematuria and nonmacroscopic hematuria group. Results: Of the 363 wasp sting patients, 219 were male and 144 were female, with a mean age of 55.9 ± 16.3 years. Fifty-one (14%) had macroscopic hematuria, 39 (10.7%) had AKI, 105 (28.9%) had rhabdomyolysis, 61 (16.8%) had hemolysis, 45 (12.4%) went on to received hemodialysis, and 14 (3.9%) died. The incidence of AKI in macroscopic hematuria group was 70.6%, and oliguric renal failure accounted for 72.2%. Patients with macroscopic hematuria had significantly higher PSS (2.2 ± 0.5 vs. 1.1 ± 0.3, p < .001). Conclusion: Macroscopic hematuria can be regarded as a surrogate marker of deteriorating clinical outcome following wasp stings. In wasp sting patients with symptoms of macroscopic hematuria or serum LDH higher than 463.5 u/L upon admission, the risk of AKI increases significantly, therefore hemodialysis should be considered. The PSS is helpful in early assessment of the severity of wasp sting patients.

Clinical manifestations of wasp stings: a case report and a review of literature

“…In the Chinese study with 1091 cases, elevated CPK was found in 53.7% of patients whereas 24.1% were diagnosed with rhabdomyolysis [4]. Similar rates have been observed in other series [26]. Although rare, myonecrosis has also been observed following wasp stings [60].…”

“…The incidence of AKI from wasp envenomation ranges from 10 to 58% [7,26,27]. The largest case series with 1091 patients from China showed an incidence of 21.0% [4].…”

“…The AKI is characteristically oliguric (70%) [26,32]. Urinalysis usually shows various amounts of red and white blood cells with or without casts.…”

“…Urinalysis usually shows various amounts of red and white blood cells with or without casts. A minority can present with gross haematuria [4,26]. There are case reports where heavy protein on dipstick was detected [25].…”

“…The levels of interleukin (IL) -6, IL-10, and IL-17 positively correlated with the risk of developing AKI [24]. The elderly [49] and patients with macroscopic haematuria had a severe course of illness [26].…”