Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
Pediatr Nephrol. 2024 Jun;39(6):1927-1935. doi: 10.1007/s00467-023-06265-6. Epub 2024 Jan 10.
Acute kidney injury (AKI) is common in children with sepsis, chronic kidney disease, poisoning or other conditions. Wasp stings are recognized as an important etiology. Several retrospective studies have investigated AKI after wasp stings in adults, but research on children remains limited.
The study included 48 children with multiple organ dysfunction syndrome after wasp stings. Demographic data, clinical manifestations, laboratory findings, management and clinical outcomes were collected, and analyzed to identify early indicators or risk factors for AKI.
20 children (41.7%) developed AKI, and 28 (58.3%) did not. Serum creatine levels elevated mostly within 24 h from stings in children with AKI (16/20, 80%). Compared with non-AKI group, AKI group exhibited more cases with cola-colored urine, jaundice, and had higher sting numbers/body surface area (BSA) and higher revised sequential organ failure assessment scores (rSOFA) as well as higher levels of C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), lactate dehydrogenase (LDH), troponin (cTnI), creatine kinase (CK), and longer prothrombin time (PT). Both univariable and multivariable logistic regression analysis identified cola-colored urine as a potential early risk factor for AKI.
The AKI group exhibited higher sting numbers/BSA, higher levels of CRP, ALT, AST, TBIL, LDH, cTnI, and CK, as well as longer PT (p < 0.05). Our findings also suggest that cola-colored urine may serve as an early indicator or potential risk factor for AKI after wasp stings in children, which is very easy to identify for first aiders or pediatricians.
急性肾损伤（AKI）在患有脓毒症、慢性肾脏病、中毒或其他疾病的儿童中很常见。黄蜂蜇伤已被认为是一个重要的病因。有几项回顾性研究调查了成人黄蜂蜇伤后的 AKI，但对儿童的研究仍然有限。
该研究纳入了 48 例因黄蜂蜇伤而出现多器官功能障碍综合征的儿童。收集了人口统计学数据、临床表现、实验室检查结果、治疗方法和临床转归，并进行了分析，以确定 AKI 的早期指标或危险因素。
20 例（41.7%）儿童发生 AKI，28 例（58.3%）未发生 AKI。AKI 组患儿血清肌酐水平升高大多发生在蜇伤后 24 小时内（16/20，80%）。与非 AKI 组相比，AKI 组患儿出现更多的可乐色尿、黄疸，蜇伤数/体表面积（BSA）更高，改良序贯器官衰竭评估评分（rSOFA）更高，C 反应蛋白（CRP）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红素（TBIL）、乳酸脱氢酶（LDH）、肌钙蛋白（cTnI）、肌酸激酶（CK）水平更高，凝血酶原时间（PT）更长。单变量和多变量逻辑回归分析均表明，可乐色尿是 AKI 的一个潜在早期危险因素。
AKI 组蜇伤数/BSA 更高，CRP、ALT、AST、TBIL、LDH、cTnI 和 CK 水平更高，PT 更长（p<0.05）。我们的研究结果还表明，可乐色尿可能是儿童黄蜂蜇伤后 AKI 的早期指标或潜在危险因素，对于急救人员或儿科医生来说，这是非常容易识别的。
