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Nephrotic syndrome after insect sting: a case report.
Vânia Junqueira1, Beatriz Donato2, Catarina Teixeira2
1Centro Hospitalar do Oeste, Departamento de Medicina Interna, Unidade de Caldas da Rainha, Caldas da Rainha, Portugal.
Jornal Brasileiro De Nefrologia
|August 21, 2020
Summary
Minimal change disease, a cause of nephrotic syndrome, can be triggered by insect stings. This case report highlights a patient who experienced remission after treatment and relapse upon re-exposure, emphasizing avoidance for sustained recovery.
Area of Science:
- Nephrology
- Allergology
- Immunology
Background:
- Minimal change disease (MCD) is a significant cause of nephrotic syndrome in adults, accounting for up to 25% of cases.
- Allergic mechanisms, including insect stings, have been implicated in the pathogenesis of MCD.
Observation:
- A case of a woman presenting with new-onset nephrotic syndrome following a non-hymenoptera insect sting is reported.
- The patient exhibited biopsy-proven minimal change disease and a concurrent pulmonary thromboembolism.
Findings:
- Glucocorticoid therapy induced complete remission of nephrotic syndrome, with sustained response for 6 months post-discontinuation.
- A subsequent insect sting exposure in the same region and season led to a relapse of nephrotic syndrome.
- Avoidance of the specific environment resulted in sustained remission for over 4 years.
Implications:
- This case suggests a potential causal link between non-hymenoptera insect stings and minimal change disease.
- Environmental and seasonal avoidance may be a crucial management strategy for recurrent insect sting-induced MCD.
- Further research into insect venom allergens and their role in triggering nephrotic syndrome is warranted.
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