Minimal change disease after multiple wasp stings

Area of Science:

• Nephrology
• Toxicology
• Immunology

Background:

• Acute renal failure (ARF) is an uncommon complication of wasp stings.
• Nephrotic syndrome (NS) is a rare manifestation of wasp envenomation.
• Minimal change disease (MCD) following wasp stings is exceptionally rare.

Observation:

• A 67-year-old male with prior normal kidney function developed ARF and NS.
• Diagnosis of biopsy-proven MCD was established one month post-numerous wasp stings.
• The patient required hemodialysis and a prolonged course of corticosteroids and diuretics.

Findings:

• Complete resolution of NS and recovery of normal renal function occurred after 6 months of treatment.
• The patient remained free of NS with preserved renal function at 3-year follow-up.
• This case underscores the potential for wasp stings to trigger immune-mediated renal pathology.

Implications:

• Wasp envenomation should be considered in the differential diagnosis of acute kidney injury and nephrotic syndrome, particularly in biopsy-proven MCD.
• Early recognition and appropriate management, including immunosuppression, are crucial for favorable outcomes.
• Further research may elucidate the immunopathogenic mechanisms linking insect stings to glomerular disease.