Macroscopic hematuria in wasp sting patients: a retrospective study

Complement activation in wasp venom-induced acute kidney injury

Previous studies have highlighted the significant role of complement activation in kidney injuries induced by rhabdomyolysis, intravascular hemolysis, sepsis, and ischemia-reperfusion. Nevertheless, the specific role and mechanism of complement activation in acute kidney injury (AKI) caused by wasp venom remain unclear. The aim of this study was to elucidate the specific complement pathway activated and investigate complement activation in AKI induced by wasp venom. In this study, a complement-depleted mouse model was used to investigate the role of complement in wasp venom-induced AKI. Mice were randomly categorized into control, cobra venom factor (CVF), AKI, and CVF + AKI groups. Compared to the AKI group, the CVF + AKI group showed improved pathological changes in kidneys and reduced blood urea nitrogen (BUN) levels. The expression levels of renal complement 3 (C3), complement 5 (C5), complement 1q (C1q), factor B (FB), mannose-binding lectin (MBL), and C5b-9 in AKI group were upregulated compared with the control group. Conversely, the renal tissue expression levels of C3, C5, C1q, FB, MBL, and C5b-9 were decreased in the CVF + AKI group compared to those in the AKI group. Complement activation occurs through all three pathways in AKI induced by wasp venom. Furthermore, complement depletion by CVF attenuates wasp venom-induced nephrotoxicity, suggesting that complement activation plays a primary role in the pathogenesis of wasp venom-induced AKI.

Machine-learning based prediction model for acute kidney injury induced by multiple wasp stings

Acute kidney injury (AKI) following multiple wasp stings is a severe complication with potentially poor outcomes. Despite extensive research on AKI's risk factors, predictive models for wasp sting-related AKI are limited. This study aims to develop and validate a machine learning-based clinical prediction model for AKI in individuals with wasp stings. In this retrospective cohort study, conducted at a tertiary teaching hospital in Yichang, China, from July 2013 to April 2023, 214 patients with wasp sting injuries were analyzed. Using least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression, prognostic variables for AKI were identified. A nomogram incorporating these four variables was constructed. The model's performance was assessed through internal validation, leave-one-out cross-validation, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA). Among 214 patients affected by wasp stings, 34.6% (74/214) developed AKI. Following LASSO regression and multivariate logistic regression, the number of stings, presence of gross hematuria, systemic inflammatory response index (SIRI), and platelet count were identified as prognostic factors. A nomogram was constructed and evaluated for its predictive accuracy, showing an area under the curve (AUC) of 0.757 (95% CI 0.711 to 0.804) and a concordance index (C-index) of 0.75. Validation confirmed the model's reliability and superior discrimination ability over existing models, as demonstrated by NRI, IDI, and DCA. The developed nomogram effectively predicts AKI risk in wasp sting patients, facilitating early identification and management of those at risk.

A prediction nomogram for mortality in patients following wasp stings: a retrospective study

Numerous studies have shown that wasp stings can lead to serious, sometimes fatal, health outcomes. Predicting deaths associated with wasp stings remains challenging yet is of critical importance. This study was conducted to identify predictors and develop a visual model for predicting mortality following wasp stings. Clinical data from 486 patients were analyzed, dividing them into two groups: survival group (N = 435) and death group (N = 51). Various statistical methods were used to create a prognostic model, including one-way analysis, the least absolute shrinkage and selection operator (LASSO) regression, and binary logistic regression. The model's accuracy was evaluated through ROC curves, calibration plots, and decision curve analysis (DCA). The study identified four key predictors of mortality: receiving more than 50 stings, having serum lactate dehydrogenase (LDH) levels of ≥ 2200 U/L, activated partial thromboplastin time (APTT) of ≥ 90 s, and the requirement for invasive mechanical ventilation within 24 h. These factors contributed to a model with an area under the ROC curve of 0.980 (95% CI: [0.968-0.992]), indicating high calibration and applicability. The decision curve analysis confirmed the model's substantial net clinical benefit. Thus, the number of stings, serum LDH, APTT, and the need for early invasive mechanical ventilation are reliable, independent predictors of death among patients experiencing wasp stings. The developed predictive model exhibits high levels of accuracy, sensitivity, consistency, and practical use.

Analysis of risk factors for acute kidney injury in children with severe wasp stings

BACKGROUND

Acute kidney injury (AKI) is common in children with sepsis, chronic kidney disease, poisoning or other conditions. Wasp stings are recognized as an important etiology. Several retrospective studies have investigated AKI after wasp stings in adults, but research on children remains limited.

METHODS

The study included 48 children with multiple organ dysfunction syndrome after wasp stings. Demographic data, clinical manifestations, laboratory findings, management and clinical outcomes were collected, and analyzed to identify early indicators or risk factors for AKI.

RESULTS

20 children (41.7%) developed AKI, and 28 (58.3%) did not. Serum creatine levels elevated mostly within 24 h from stings in children with AKI (16/20, 80%). Compared with non-AKI group, AKI group exhibited more cases with cola-colored urine, jaundice, and had higher sting numbers/body surface area (BSA) and higher revised sequential organ failure assessment scores (rSOFA) as well as higher levels of C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), lactate dehydrogenase (LDH), troponin (cTnI), creatine kinase (CK), and longer prothrombin time (PT). Both univariable and multivariable logistic regression analysis identified cola-colored urine as a potential early risk factor for AKI.

CONCLUSIONS

The AKI group exhibited higher sting numbers/BSA, higher levels of CRP, ALT, AST, TBIL, LDH, cTnI, and CK, as well as longer PT (p < 0.05). Our findings also suggest that cola-colored urine may serve as an early indicator or potential risk factor for AKI after wasp stings in children, which is very easy to identify for first aiders or pediatricians.

Wasp venom-induced acute kidney injury: current progress and prospects

Wasp venom can trigger local and systemic reactions, with the kidneys being commonly affected, potentially causing acute kidney injury (AKI). Despite of the recent advances, our knowledge on the underlying mechanisms of toxicity and targeted therapies remain poor. AKI can result from direct nephrotoxic effects of the wasp venom or secondary rhabdomyolysis and intravascular hemolysis, which will release myoglobin and free hemoglobin. Inflammatory responses play a central role in these pathological mechanisms. Noteworthily, the successful establishment of a suitable experimental model can assist in basic research and clinical advancements related to wasp venom-induced AKI. The combination of therapeutic plasma exchange and continuous renal replacement therapy appears to be the preferred treatment for wasp venom-induced AKI. In addition, studies on cilastatin and varespladib for wasp venom-induced AKI treatment have shown their potential as therapeutic agents. This review summarizes the available evidence on the mechanisms and treatment of wasp venom-induced AKI, with a particular focus on the role of inflammatory responses and potential targets for therapeutic drugs, and, therefore, aiming to support the development of clinical treatment against wasp venom-induced AKI.

Acute Kidney Injury Complicating Wasp Stings: A Report of Two Cases and Literature Review

Acute kidney injury could occasionally complicate wasp stings. We describe two such cases. The first one developed acute kidney injury as a result of rhabdomyolysis and hemolysis, whereas the other patient developed acute kidney injury as part of multiorgan dysfunction syndrome resulting from shock and rhabdomyolysis. Both remained dependent on intermittent hemodialysis for a short period of time before recovering spontaneously. These cases highlight different pathophysiological processes leading to acute kidney injury, and the importance of timely diagnosis to achieve favourable clinical outcomes.

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

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.

Phospholipase A2 inhibitor varespladib prevents wasp sting-induced nephrotoxicity in rats

This study aimed to clarify whether varespladib, a phospholipase A₂ (PLA₂) inhibitor, can be used as a therapeutic agent for wasp sting-induced acute kidney injury (AKI). Rats were divided into control, AKI, and AKI + varespladib groups. The AKI model was established by subcutaneously injecting wasp venom at five different sites in rats. Varespladib treatment showed a significant inhibitory effect on wasp venom PLA₂in vitro and in vivo. Moreover, we observed that varespladib decreased the levels of rhabdomyolysis and hemolysis markers compared with that in the AKI group. Histopathological changes in the kidney decreased significantly, and rat serum creatinine levels were reduced after varespladib administration. The significantly regulated genes in the kidney of the AKI group were mostly involved in inflammatory response pathway, and the administration of varespladib remarkably attenuated the expression of these genes. Therefore, varespladib inhibited wasp sting-induced functional and pathological damage to the kidneys. We propose that the PLA₂ inhibitor varespladib protects the kidney tissue in a wasp sting-induced AKI model by inhibiting PLA₂ activity.