Gong Jianhua, Yuan Hai, Gao Zhao, Hu Fengqi
Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441000, Hubei, China.
Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441000, Hubei, China.
Toxicon. 2019 May;163:1-7. doi: 10.1016/j.toxicon.2019.03.008. Epub 2019 Mar 14.
Stinging accidents involving wasp venom are a notable cause of acute kidney injury (AKI) in Asia. However, very little attention has been paid to the understanding of the mechanisms involved in this type of AKI. The aims of this review are to explore the evidence for the mechanisms and the therapeutic role of renal replacement therapy of wasp venom and AKI. A systematic literature search was conducted using PubMed for the association among wasp venom and AKI. Wasp venom is a complex mixture of biologically active components, including enzymes, amines, and peptides. Wasp venom may induce local anaphylaxis reactions as well as systemic reactions such as AKI. AKI may develop as a result of direct nephrotoxic effects of the venom or secondary intravascular hemolysis and/or rhabdomyolysis. Histopathological features of renal biopsies predominantly include acute tubular necrosis and acute interstitial nephritis. Renal replacement therapy, which includes intermittent hemodialysis, hemoperfusion, plasmapheresis, continuous renal replacement therapy, and peritoneal dialysis, has been used to treat severe AKI cases induced by wasp stings. Continuous renal replacement therapy appears to provide more benefit than intermittent hemodialysis in the treatment of wasp sting-induced AKI. In this review, we summarize the existing evidence of the mechanisms and treatment for venom-induced AKI, with a particular emphasis on the role of renal replacement therapy in the management of severe AKI following massive wasp stings.
在亚洲，黄蜂毒液导致的蜇伤事故是急性肾损伤（AKI）的一个显著原因。然而，对于这类急性肾损伤所涉及机制的了解却很少受到关注。本综述的目的是探讨黄蜂毒液与急性肾损伤的机制及肾脏替代治疗的作用的证据。使用PubMed对黄蜂毒液与急性肾损伤之间的关联进行了系统的文献检索。黄蜂毒液是生物活性成分的复杂混合物，包括酶、胺和肽。黄蜂毒液可能引发局部过敏反应以及诸如急性肾损伤等全身反应。急性肾损伤可能是由于毒液的直接肾毒性作用或继发性血管内溶血和/或横纹肌溶解所致。肾活检的组织病理学特征主要包括急性肾小管坏死和急性间质性肾炎。肾脏替代治疗，包括间歇性血液透析、血液灌流、血浆置换、连续性肾脏替代治疗和腹膜透析，已被用于治疗黄蜂蜇伤所致的严重急性肾损伤病例。在治疗黄蜂蜇伤所致急性肾损伤方面，连续性肾脏替代治疗似乎比间歇性血液透析更有益。在本综述中，我们总结了毒液诱导的急性肾损伤的机制和治疗的现有证据，特别强调了肾脏替代治疗在大量黄蜂蜇伤后严重急性肾损伤管理中的作用。
