https://orcid.org/0000-0003-0731-657X
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S Ezhilnilavan, P S Priyamvada, B H Srinivas, H Satish, S Parameswaran, Acute tubulointerstitial nephritis following hymenopteran stings, Postgraduate Medical Journal, Volume 94, Issue 1113, July 2018, Pages 418–420, https://doi.org/10.1136/postgradmedj-2018-135608
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Introduction
Wasps and bees are insects that belong to the order Hymenoptera. Hymenopteran sting can lead to renal failure, secondary to acute tubular necrosis. Acute tubulo interstitial nephritis is an uncommon, perhaps underdiagnosed clinical manifestation resulting from delayed hypersensitivity reaction to the venom.
Case 1
The first patient, an elderly woman, sustained a single Indian wasp sting (Vespa affinis) on the left index finger. She noticed mild redness, swelling and pain over the finger. The patient herself removed the sting, and an indigenous remedy (turmeric paste) was applied to the area. There was no history of administration of any oral or parenteral medications following the sting. The patient had no previous comorbidities and was not on any other long-term medications. There was no previous history of stings as well. Five days later, the patient started noticing pedal oedema which gradually increased over a few days. Along with oedema, she also noticed a gradual reduction in the urine output. The patient was referred to our hospital on the 10th day after sustaining the sting. On admission, there was bilateral pedal oedema; no pallor, icterus, bleeding manifestations or rashes. Her blood pressure was 190/80 mm Hg, and the systemic examination was unremarkable. The blood urea nitrogen was 31.7 mmol/L, and creatinine was 1225.6 μmol/L. Abdominal imaging showed normal-sized kidneys.The other laboratory parameters are given in table 1.
