Minimal Change Glomerulonephritis following a Wasp Sting

Zaman, Fahim; Saccaro, Steven J.; Latif, Shahnila; Atray, Naveen K.; Abreo, Kenneth

doi:10.1159/000046653

Cited by 9 publications

(4 citation statements)

References 8 publications

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“…The response to steroid treatment is favorable in 50% of patients with glomerulonephritis after bee sting and in an even greater proportion of patients with minimal change disease. 68 70 Of the pediatric patients, 20% required peritoneal dialysis.…”

Section: Pathophysiologymentioning

confidence: 99%

Animal toxins and the kidney

Sitprija

2008

Nat Rev Nephrol

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Envenomation or poisoning by toxins from animals poses an important health hazard in the tropics. Animal toxins are complex mixtures of proteins, peptides, enzymes and chemicals. These toxins exert their effects through modulation of ion channels and receptors, and via direct enzyme action. Depolarization or hyperpolarization of ion channels--caused by most marine toxins, and some snake and insect venoms--results in neuromuscular symptoms that can be associated with hemodynamic changes. Toxin enzymes, especially proteases and phospholipase A2, initiate inflammatory processes that involve the generation of proinflammatory cytokines and vasoactive mediators, resulting in systemic and renal hemodynamic alterations. Toxin enzymes also have direct effects on erythrocytes, myocytes, blood coagulation factors, vascular endothelium and epithelial cells. As a result, disseminated intravascular coagulation, bleeding diathesis, intravascular hemolysis and rhabdomyolysis are common after exposure to animal toxins. The renal manifestations of animal toxin envenomation, which are usually acute, result mainly from these enzymatic effects. All renal structures can be affected by animal toxins, and tubular necrosis is common. Acute kidney injury is attributed to decreased renal blood flow (associated with intravascular hemolysis or rhabdomyolysis), disseminated intravascular coagulation or direct tubular toxicity. Immunologic mechanisms have a minor role in the pathophysiology of nephropathy caused by animal toxins.

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Section: Pathophysiologymentioning

confidence: 99%

Animal toxins and the kidney

Sitprija

2008

Nat Rev Nephrol

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“…The association between insect stings and NS is rare and the evidence of a biopsy compatible with MCD in this setting is even less frequent. 8 Fanconi et al, in 1951, were among the first who associated allergy and NS and since then various reports suggest a strong relationship between these two entities. 9 The authors described a case of NS in a young woman, in which the diagnosis was easily established based on clinical and laboratory findings and MCD was confirmed by renal biopsy.…”

Section: Discussionmentioning

confidence: 99%

Nephrotic syndrome after insect sting: a case report

Junqueira¹,

Donato

Teixeira

et al. 2020

Braz. J. Nephrol.

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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.

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“…Rare mechanisms of kidney injury, such as, renal cortical necrosis [43] and thrombotic microangiopathy [44] have been documented. Although exceptionally rare, nephrotic syndrome [45] with minimal change [46] and mesangial-proliferative glomerulonephritis [47] have been reported following wasp stings.…”

Section: Renal Effectsmentioning

confidence: 99%

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

Ruwanpathirana

Priyankara²

2022

Trop Med Health

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Background Wasp stinging, a neglected tropical entity can have a myriad of local and systemic effects. We present a case of multi-organ injury following multiple wasp stings and a review of literature on the systemic manifestations of wasp stings. Case presentation A 48-year-old Sri Lankan male who suffered multiple wasp stings, developed an anaphylactic shock with respiratory failure, which was treated with adrenaline and mechanical ventilation. Within the next 2 days the patient developed acute fulminant hepatitis, stage III acute kidney injury, rhabdomyolysis, haemolysis and thrombocytopenia. The patient was treated in the intensive care unit with ionopressors and continuous renal replacement therapy (CRRT). Haemoadsorbant therapy was used in adjunct with CRRT. There was a gradual recovery of the organ functions over the 1st week. However, the patient succumbed to fungal sepsis on the 16th day despite treatment. We conducted a literature review to identify the various clinical manifestations of wasp stinging. Wasp venom contains enzymes, amines, peptides and other compounds. These proteins can cause type 1 hypersensitive reactions ranging from local skin irritation to anaphylactic shock. Furthermore, the toxins can cause direct organ injury or delayed hypersensitivity reactions. The commonly affected organs are the kidneys, liver, and muscles. The effect on the haematological system manifests as coagulopathy and/or cytopenia. The heart, nervous system, lungs, intestines and skin can be affected rarely. Treatment is mainly supportive. Conclusion In conclusion, wasp envenomation can result in multi-organ injury and attention should be paid in doing further research and establishing evidence-based treatment practices.

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Minimal Change Glomerulonephritis following a Wasp Sting

Cited by 9 publications

References 8 publications

Animal toxins and the kidney

Animal toxins and the kidney

Nephrotic syndrome after insect sting: a case report

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

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