Non-fatal acute renal failure due to wasp stings in children

Abstract

We report two children who developed acute renal failure after multiple wasp stings. Each case involved intravascular hemolysis which caused acute renal failure, volume overload, hypertension, anemia, hyponatremia, hyperkalemia, and metabolic acidosis. Peritoneal dialysis was required for short periods. The children recovered completely with blood urea nitrogen and creatinine returning to normal within 3 months. One child had a renal biopsy which showed mild tubulointerstitial nephritis. Although there is no specific treatment or antivenom, dialysis and supportive care have proved to be successful.

Acute renal failure following wasp sting in children

“…In our previous report on two children (patients 1 and 2, Table 1), one child had a renal biopsy performed which showed mild tubulointerstitial nephritis: interstitial edema with massive infiltration with eosinophils, lymphocytes and plasma cells, and immunofluorescence demonstrated positive IgM in a linear pattern (the second child had no biopsy, nor did the five patients we added for the current study) [20]. Intravascular hemolysis has been reported in most reports discussing wasp sting complications in the literature [4,8,9,11,13,14,22] as in our reviewed patients, in which six had anemia, three of which in turn had a hematocrit of less than 25 which could not be explained only from a dilutional effect due to volume overload; hemolysis has previously been noted as a major reaction in ARF [3,11].…”

“…All of the mortalities in Thiruventhiran's study had a renal biopsy performed which showed ATN [19]. Interstitial nephritis caused from ARF has also been noted [3,20]. Zhang et al [23] reported a patient of hypersensitivity reaction leading to acute tubulointerstitial nephritis following wasp sting, while recently D'Cruz et al [7] reported a wasp sting associated with type I renal tubular acidosis.…”

Acute renal failure following multiple wasp stings

“…Wasp venom contains histamine, serotonin, dopamine, wasp kinin, phospholipases and hyaluronidase [7]. Severe intravascular hemolysis, more frequently noted with wasp than bee stings, is due to the effect of wasp kinin and phospholipase A [5,6,7,8,9]. This together with rhabdomyolysis caused by polypeptides, histamine, serotonin and acetylcholine might result in variable degrees of acute tubular necrosis, which is the chief histopathological finding [6].…”

“…However, wasp stings are potentially more dangerous and likely to be associated with lifethreatening complications [4]. Intravascular hemolysis, rhabdomyolysis, hepatocyte damage, thrombocytopenia, coagulopathy, ARF, cardiovascular and neurological abnormalities are the most common noted features following systemic envenomation [2,3,4,5,6]. The exact pathophysiology of ARF following wasp stings is unclear, but is mainly attributed to hemolysis, rhabdomyolysis, disseminated intravascular coagulation, ischemia due to initial anaphylaxis and the direct nephrotoxicity of the venom [2,3,4,5,6].…”

“…Vespa orientalis is the most common species found in the plains of Nepal. The occurrence of acute renal failure (ARF) following wasp stings is rare and is attributed to intravascular hemolysis, rhabdomyolysis or toxic effects of the venom [2,3,4,5,6]. We report the cases of two patients with ARF secondary to multiple wasp stings.…”