title: Wasp sting-induced acute kidney injury.
abstract: BACKGROUND
  Wasp stings are a common form of envenomation in tropical countries, especially in farmers. The aim of this study was to document the clinical presentation, treatment and outcomes of patients with acute kidney injury (AKI) due to multiple wasp stings in a tertiary care hospital.
  
  
  METHODS
  We conducted a retrospective observational study of patients with multiple wasp stings and AKI at the Department of Nephrology between July 2011 and August 2015. The clinical features, laboratory data, treatment details and outcomes were noted.
  
  
  RESULTS
  A total of 11 patients were included. All were from rural areas. All of them were males with age ranging from 21 to 70 years, mean age 45 ± 23 years. Six had oliguria and two had hypotension. All 11 patients had evidence of rhabdomyolysis and three also had hemolysis. Ten patients required hemodialysis with a mean number of hemodialysis sessions of 8.7 ± 2.8. Renal biopsy carried out on four patients, showed acute interstitial nephritis (AIN) in one patient, acute tubular necrosis (ATN) in two patients, and one patient had both AIN and ATN. The two patients with AIN were given steroids, while all other patients were managed with supportive measures. One patient died within 48 h of presentation due to shock. At a mean follow-up of 24 months, one had progressed to chronic kidney disease and the remaining nine had normal renal function.
  
  
  CONCLUSIONS
  Wasp sting is an occupational hazard. AKI was most commonly due to rhabdomyolysis. Early renal biopsy is indicated in those patients who do not respond to supportive measures. Timely dialysis and steroid in the case of AIN improves renal survival.
authors.affiliation: Department of Nephrology , Madras Medical College and Rajiv Gandhi Government General Hospital , Chennai , India.
authors.forename: Jeyachandran
authors.initials: J
authors.lastname: Dhanapriya
authors.affiliation: Department of Nephrology , Madras Medical College and Rajiv Gandhi Government General Hospital , Chennai , India.
authors.forename: Thanigachalam
authors.initials: T
authors.lastname: Dineshkumar
authors.affiliation: Department of Nephrology , Madras Medical College and Rajiv Gandhi Government General Hospital , Chennai , India.
authors.forename: Ramanathan
authors.initials: R
authors.lastname: Sakthirajan
authors.affiliation: Department of Nephrology , Madras Medical College and Rajiv Gandhi Government General Hospital , Chennai , India.
authors.forename: Palaniselvam
authors.initials: P
authors.lastname: Shankar
authors.affiliation: Department of Nephrology , Madras Medical College and Rajiv Gandhi Government General Hospital , Chennai , India.
authors.forename: Natarajan
authors.initials: N
authors.lastname: Gopalakrishnan
authors.affiliation: Department of Nephrology , Madras Medical College and Rajiv Gandhi Government General Hospital , Chennai , India.
authors.forename: Thoppalan
authors.initials: T
authors.lastname: Balasubramaniyan
keywords: acute kidney injury; hemodialysis; rhabdomyolysis; steroids; wasp stings