ABSTRACT
Bee stings can cause severe reactions and have caused many victims in the last years.
Allergic reactions can be triggered by a single
sting and the greater the number of
stings, the worse the
prognosis. The
poisoning effects can be systemic and can eventually cause
death. The
poison components are melitin,
apamin,
peptide 401,
phospholipase A2,
hyaluronidase,
histamine,
dopamine, and
norepinephrine, with melitin being the main lethal component.
Acute kidney injury (AKI) can be observed in
patients suffering from
bee stings and this is due to multiple factors, such as
intravascular hemolysis,
rhabdomyolysis,
hypotension and direct
toxicity of the
venom components to the renal tubules. Arterial
hypotension plays an important
role in this type of AKI, leading to ischemic renal lesion. The most commonly identified
biopsy finding in these cases is acute tubular
necrosis, which can occur due to both, ischemic
injury and the nephrotoxicity of
venom components.
Hemolysis and
rhabdomyolysis reported in many cases in the
literature, were demonstrated by elevated
serum levels of indirect
bilirubin and
creatine kinase. The severity of AKI seems to be associated with the number of
stings, since
creatinine levels were higher, in most cases, when there were more than 1,000
stings. The aim of this study is to present an updated
review of AKI associated with
bee stings, including the currently advised clinical approach.