Recovery from AKI Following Multiple Wasp Stings

Abstract

SummaryBackground and objective To observe the outcomes of AKI following multiple wasp stings.Design, setting, participants, & measurements Eighty-one patients (mean age 6 SD, 45.5614.7 years; 55 men and 26 women; mean Acute Physiology and Chronic Health Evaluation II score, 16.8562.78) with AKI following multiple wasp stings between 1997 and 2011 were retrospectively analyzed. Data on their demographic characteristics, initial modalities of renal replacement therapy (RRT), urine output, serum creatinine, bilirubin, myoglobin, and other variables were collected. Renal outcomes included complete recovery of kidney function, CKD, and death. Subgroup analysis was performed according to initial modality of RRT in the first 48 hours, including continuous veno-venous hemofiltration (CVVH), intermittent hemodialysis (IHD), and CVVH plus plasma exchange (PE).Results Of the 75 patients available for follow-up, 7 (9.3%) died, and 8 (10.7%, all in the IHD group) developed CKD. The average RRT time was 18.268.4 days, and the average kidney function recovery time was 36.0 (29.0, 41.0) days. Subgroup analysis showed no difference in the mortality rates between the CVVH, CVVH + PE, and IHD groups (8.0%, 7.1%, and 11.1%, respectively; P.0.99). The recovery time for kidney function was significantly shorter in the CVVH and CVVH + PE groups than in the IHD group (31.968.5 days, 28.669.4 days, and 41.668.1 days, respectively; P,0.001).Conclusions This is a large case series report on the outcomes of patients with AKI following multiple wasp stings. Most patients survived with complete recovery of their kidney function. Despite the lack of difference in mortality rates, the patients who began RRT with CVVH and CVVH + PE experienced a better and more rapid recovery of kidney function than those initiated with IHD.

Acute kidney injury and rhabdomyolysis due to multiple wasp stings

“…In a large case series of 75 patients from china, 7 (9.3%) died, and 8 (10.7%) developed chronic kidney disease (CKD). [6] Most other patients survived with complete recovery of their kidney function. Further analysis showed no difference in the mortality rates between the modality of dialysis (continuous and intermittent with or without plasma exchange).…”

Acute tubulointerstitial nephritis following hymenopteran stings

“…In addition to phospholipase A2 and hyaluronidase, bee venom contains the toxic peptide melittin which acts as a detergent, enhancing the effects of phospholipase A2 on renal tubular cells, muscle cells and red blood cells. In addition, other biologically active substances like histamine, 5-hydroxytryptamine, acetylcholine, phosphomonoesterase, α-d-glucosidase, kinins and peptides can trigger the inflammatory cascade many folds 3. Alternatively, patients may develop acute kidney injury (AKI) secondary to anaphylactic shock.…”

Wasp stings (Vespa affinis) induced acute kidney injury following rhabdomyolysis in a 25-year-old woman

“…Sometimes wasp stings are wrongly called bee stings. The body shape of wasps is smooth and they sting repeatedly and occurrences happen near their nest or near soft drinks and cans, while the body shape of bees is fuzzy and they sting only once near their hive or flowers (6). Mass envenomation may occur when these insects respond to others as a threat to their colony.…”

“…Even regular dialysis failed to normalize creatinine for some days, probably because of the delayed release of toxins and low renal clearance. Wasp venom contains various biogenic substances that include polypeptides like apamin, enzymes (phospholipase A 2 and hyaluronidase), and low molecular weight agents like histamine and amino acids (6). Phospholipase is the most important component causing rhabdomyolysis and can also cause hemolysis (6,8).…”