dos Reis M A, Costa R S, Coimbra T M, Dantas M, Gomes U A
Department of General Pathology, Faculty of Medicine, Triângulo Mineiro, Brazil.
Kidney Blood Press Res. 1997;20(4):271-7. doi: 10.1159/000174157.
Human envenomation caused by bee or wasp stings has been reported to cause acute renal failure (ARF), usually due to acute tubular necrosis (ATN), as a frequent complication. The pathogenetic mechanisms of ATN occurring in these accidents are still unclear. In the present study, female Wistar rats weighing 150-200 g were injected intravenously with Africanized bee venom at a dose of 0.4 microl/100 g body weight and used in functional and light microscopy studies. The animals were divided into two groups: the early group was studied 3-8 h after inoculation, and the late group was studied 24-30 h thereafter. The animals showed ARF characterized by reduction of glomerular filtration rate with increasing levels of plasma creatinine. They also showed increased fractional sodium and potassium excretions, suggesting changes in the proximal portion of the nephron. The water transport through collecting tubules was reduced, with consequent diuresis, indicating functional changes in the distal portion of the nephron. These functional changes were more marked in the early group, with recovery tending to occur after 24 h. Albuminuria was also observed in this group. Light microscopy showed ATN mainly in cortex and outer medulla, with isolated necrosis in cells or small groups of cells and cast formation in the distal and collecting tubules. After 24 h frequent mitotic figures were found in the tubular epithelium. The observed ARF was due to ATN which in turn was probably caused by multiple effects, mainly hemodynamic changes secondary to cardiotoxicity and systemic vasodilation caused by the venom, myohemoglobinuria, and the direct action of the venom on tubular cells.
据报道，蜜蜂或黄蜂蜇伤导致的人类中毒常引发急性肾衰竭（ARF），通常是由于急性肾小管坏死（ATN）所致。这些事故中发生ATN的发病机制仍不清楚。在本研究中，将体重150 - 200克的雌性Wistar大鼠以0.4微升/100克体重的剂量静脉注射非洲化蜜蜂毒液，并用于功能和光学显微镜研究。动物被分为两组：早期组在接种后3 - 8小时进行研究，晚期组在随后的24 - 30小时进行研究。动物表现出ARF，其特征为肾小球滤过率降低以及血浆肌酐水平升高。它们还表现出钠和钾排泄分数增加，提示肾单位近端部分发生了变化。通过集合管的水转运减少，从而导致利尿，表明肾单位远端部分发生了功能变化。这些功能变化在早期组更为明显，24小时后有恢复趋势。该组还观察到蛋白尿。光学显微镜显示ATN主要发生在皮质和外髓质，细胞或小细胞群有局灶性坏死，远端和集合管有管型形成。24小时后，在肾小管上皮中发现频繁的有丝分裂象。观察到的ARF是由于ATN，而ATN反过来可能是由多种作用引起的，主要是毒液引起的心脏毒性和全身血管扩张继发的血流动力学变化、肌红蛋白尿以及毒液对肾小管细胞的直接作用。
