Acute Kidney Injury in Children Following Multiple Wasp Stings and its Immediate Outcome

Background: Wasp bites usually bring temporary discomfort and pain, but on occasion, massive wasp stings can cause fatal allergic reactions and multiple organ failure including acute kidney injury (AKI), hepatic failure and circulatory collapse. Objective: This study was undertaken to find out the type of renal injury and immediate outcome of treatment of AKI following multiple wasp stings among children. Methods: It was a prospective study conducted in Dhaka Shishu (Children) Hospital from July 2012 to June 2014. During this period admitted children with AKI following wasp bite were included in the study. Detail history was recorded and clinical examinations and investigations including renal biopsy were performed to every patient. All patients underwent peritoneal dialysis. Result: Total 18 children were admitted with AKI following multiple wasp stings during the study period. Among them male were 14(78%) and female were 4(22%) with a male female ratio of 3.5:1. Mean age was 4.65±3.23 year and mean wasp bites number was 30.80±15.46 (range11-48). Four patients (22%) developed secondary hypertension. kidney biopsy showed acute tubulointerstitial nephritis in13 (72%) and Acute tubular necrosis in 5(18%) children. All patients recovered after peritoneal dialysis but recovery of renal function was delayed in victims with larger numbers of wasp envenomation, and they needed multiple peritoneal dialyses and had other severe complications. Conclusions: Clinicians should be aware that children with multiple wasp stings are at risk of AKI and secondary hypertension. We suggest hospitalization as early as possible to provide intensive dialytic support to ensure good renal recovery with shortest period and reduce morbidity.