Macroscopic hematuria in wasp sting patients: a retrospective study

Ren Fail. 2021 Dec;43(1):500-509. doi: 10.1080/0886022X.2021.1896547.

Abstract

Background: Macroscopic hematuria after wasp sting has been reported in Asia to occur before acute kidney injury (AKI), and is often used by clinicians as a sign indicating the need for intensive care and blood purification therapy. However, there is no study on the clinical characteristics and prognosis of this symptom.

Methods: The clinical data of 363 patients with wasp sting admitted to Suining Central Hospital from January 2016 to December 2018 were retrospectively analyzed. At admission, the poisoning severity score (PSS) was used as the criterion for severity classification. According to the presence of macroscopic hematuria, the patients were divided into macroscopic hematuria and non-macroscopic hematuria group.

Results: Of the 363 wasp sting patients, 219 were male and 144 were female, with a mean age of 55.9 ± 16.3 years. Fifty-one (14%) had macroscopic hematuria, 39 (10.7%) had AKI, 105 (28.9%) had rhabdomyolysis, 61 (16.8%) had hemolysis, 45 (12.4%) went on to received hemodialysis, and 14 (3.9%) died. The incidence of AKI in macroscopic hematuria group was 70.6%, and oliguric renal failure accounted for 72.2%. Patients with macroscopic hematuria had significantly higher PSS (2.2 ± 0.5 vs. 1.1 ± 0.3, p < .001).

Conclusion: Macroscopic hematuria can be regarded as a surrogate marker of deteriorating clinical outcome following wasp stings. In wasp sting patients with symptoms of macroscopic hematuria or serum LDH higher than 463.5 u/L upon admission, the risk of AKI increases significantly, therefore hemodialysis should be considered. The PSS is helpful in early assessment of the severity of wasp sting patients.

Keywords: AKI; Wasp sting; macroscopic hematuria; poisoning severity score; rhabdomyolysis.

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / therapy
  • Adult
  • Aged
  • Animals
  • China / epidemiology
  • Female
  • Hematuria / epidemiology
  • Hematuria / etiology*
  • Hematuria / therapy
  • Humans
  • Insect Bites and Stings / complications*
  • L-Lactate Dehydrogenase / blood*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Renal Dialysis / statistics & numerical data
  • Retrospective Studies
  • Rhabdomyolysis / epidemiology
  • Severity of Illness Index
  • Wasp Venoms / toxicity*
  • Wasps

Substances

  • Wasp Venoms
  • L-Lactate Dehydrogenase

Grants and funding

This work was supported by the Grant from the University of Electronic Science and Technology of China Central University Research Fund [ZYGX2019J104, under Grant from the Science and Technology Project of Sichuan Province [2020YJ0447], the Grant from the National Natural Science Foundation of China [No. 81970641], and the Grant from Renal Department and Institute of Nephrology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Sichuan Clinical Research Center for Kidney Diseases. These grants played a role in data collection of these patient, as well as the interpretation of data and the manuscript writing.