Acute renal failure following multiple wasp stings

We report the cases of two patients who developed acute renal failure following multiple wasp stings. Both patients required dialysis and recovered within 4 weeks. The kidney biopsy from one patient showed acute tubular necrosis with interstitial nephritis. One patient had complete recovery of renal function on follow-up, while the other was lost to follow-up.     

Rhabdomyolysis and acute renal failure in children

Acute renal failure (ARF) is an important complication of rhabdomyolysis. However, the contributing factors to the development of ARF in children with rhabdomyolysis remain obscure. The aim of this study was to clarify the factors contributing to the development of ARF in children with rhabdomyolysis. This is a retrospective review of the clinical characteristics, laboratory data, pediatric risk of mortality (PRISM) scores, the occurrence of systemic inflammatory response syndrome (SIRS) criteria, and the number of dysfunctional organs in 18 children with rhabdomyolysis seen in our hospital between 1991 and 2000. The patients were divided into an ARF group (n=9) and a non-ARF group (n=9). All patients with ARF had more than two dysfunctional organs. The incidence of dehydration, serum concentrations of myoglobin, creatinine kinase, aspartate aminotransferase, and lactate dehydrogenase, PRISM scores, and the numbers of SIRS criteria and dysfunctional organs were higher in the ARF group than the non-ARF group. The blood pH and base excess, and urinary pH were lower in the ARF group than in the non-ARF group. These results suggest that ARF is more likely to develop in the presence of dehydration, metabolic acidosis, or severe muscle damage, or with multiple organ failure in children with acute rhabdomyolysis. Received: 12 April 2001 / Revised: 20 August 2001 / Accepted: 21 August 2001     

Wasp envenomation-induced acute renal failure: a report of three cases

Acute renal failure is an unusual complication of wasp stings. We report three cases who developed acute renal failure after multiple wasp stings (Vespa magnifica). Two patients had evidence of intravascular haemolysis and rhabdomyolysis whereas one patient investigation showed no evidence of intravascular haemolysis or rhabdomyolysis. All three cases had impaired liver functions. Oligo-anuria was seen in all three of the patients and all of them required dialytic support. One patient died of massive gastrointestinal bleeding while the remaining two recovered completely. Although acute renal failure after wasp stings is typically caused by acute tubular necrosis in the setting of haemolysis or rhabdomyolysis, in some patients, renal failure may result from a direct nephrotoxic effect or acute interstitial nephritis from a hypersensitivity reaction to the wasp venom.     

Acute renal failure in children with idiopathic nephrotic syndrome

Acute renal failure (ARF) is an uncommon but alarming complication of idiopathic nephrotic syndrome. The renal failure could be secondary to causes evident from the history and evaluation, such as severe intravascular volume depletion, acute tubular necrosis, allergic interstitial nephritis, bilateral renal vein thrombosis, acute pyelonephritis, or rapid progression of the original glomerular disease. It may be termed idiopathic if the underlying cause is undetermined. We present three children with idiopathic nephrotic syndrome who were admitted with acute renal failure. One case was due to drug-induced allergic interstitial nephritis. The other two were idiopathic in nature. Improvement in renal function occurred in the three patients over a variable period of 10 days to 4 weeks. After careful exclusion of well-known causes of acute renal failure, idiopathic acute renal failure (IARF) should be considered as a diagnostic possibility in these patients. The exact pathophysiology of IARF is not understood. Possible proposed explanations include interstitial edema, tubular obstruction, altered glomerular permeability, and unrecognized hypovolemia.     

Rhabdomyolysis and acute renal failure in a child with influenza A infection

A 13-year-old previously healthy girl developed rhabdomyolysis and acute renal failure during influenza A infection. The patient recovered renal function completely with supportive therapy. This complication has been described in adult patients, but progression to acute renal failure in this context has not been reported previously in children. This diagnosis should be considered in the differential diagnosis of a pediatric patient presenting with acute renal failure and viral symptomatology. Received July 16, 1996; received in revised form and accepted November 6, 1996     

Acute renal failure due to interstitial nephritis after intravesical instillation of BCG

Intravesical chemotherapy with bacilli Calmette-Guerin (BCG) has been an established therapy for preventing recurrence of, and for treatment of, superficial transitional cell carcinoma of the bladder, but it is not without side effects. A variety of renal complications have been reported and attributed to mycobacterial infection. Although renal complications are uncommon, several cases of interstitial nephritis (with or without granulomas) and mesangial glomerulonephritis have been reported. We report a 76-year-old male patient who developed acute renal failure due to interstitial nephritis after intravesical instillation of BCG. Corticosteroids may serve the recovery of renal function without concomitant use of anti-tubercular therapy, provided systemic signs and mycobacterial infection are absent. Serum creatinine should be checked in at-risk patients in order to detect this complication early.     

Acute tubulointerstitial nephritis after wasp stings

A 61-year-old Caucasian man presented with acute renal failure after multiple wasp stings. The patient required dialysis support temporarily. Work-up failed to show rhabdomyolysis or hemolysis and a kidney biopsy revealed acute allergic interstitial nephritis. The patient's renal function recovered completely after a short course of steroid therapy. Acute renal failure after wasp stings is typically caused by acute tubular necrosis in the setting of hemolysis or rhabdomyolysis. Compared with previously reported cases of acute renal failure associated with bee stings, our patient is unique in that his renal failure was caused by a hypersensitivity reaction apparently to the wasp venom. © 2001 by the National Kidney Foundation, Inc.     

Peritonitis as a risk factor of acute renal failure in nephrotic children

Idiopathic acute renal failure (IARF) is an uncommon but severe complication in children with relapsing nephrotic syndrome and may require long-term dialytic support until recovery of renal function takes place. Due to limited understanding of the pathophysiology of IARF, specific guidelines for its prevention and therapy have not been developed. Among triggering factors, peritonitis was present in half of all pediatric patients with this complication described in the English literature over the past 15 years. We report an additional nephrotic child who developed IARF following spontaneous bacterial peritonitis. The renal biopsy showed tubular epithelial changes consistent with acute tubular necrosis. A discussion of related literature and possible pathogenesis of this association is presented. Received: 13 September 1999 / Revised: 18 April 2000 / Accepted: 23 April 2000     

Severe rhabdomyolysis and acute renal failure due to multiple wasp stings

Sir, Rhabdomyolysis has been implicated as the cause of acute renalfailure in 5–7% of cases [1]. Many cases of rhabdomyolysis-associatedacute renal failure have been published, but those due to beeor wasp stings are quite rare [2–4], and are     

Rhabdomyolysis and acute renal failure in severely burned patients

Rhabdomyolysis (RML) is a precarious complication in severely burned patients and the principal treatment goal is prevention of acute renal failure (ARF). This 10-year retrospective study analyses the causes for RML in severely burned patients and evaluates treatment algorithms. Eight of 714 patients (1%) were diagnosed with RML. Percentage TBSA burn was 25 ± 13%. The mean abbreviated burn severity index score (ABSI) was 9 ± 2. ARF was found in 75% (6/8) of the patients. Serum myoglobin (MB) was reduced by 41 ± 16% after 24-h treatment by solitary volume repletion (VR) and by 44 ± 20% through VR + continuous veno-venous hemodiafiltration (CVVHDF). Mortality was 50% (4/8). Peak mean CPK-levels were more than two and MB-levels more than four times higher in non-survivors than in survivors. Burns associated with RML result in poor survival. VR and CVVHDF are effective measures in treating RML. CVVHDF is effective in removing MB when using high flux filter membranes. Early CVVHDF (within 24 h of diagnosis) with high-cut off membranes could reduce the risk of ARF and mortality.     

Acute renal failure due to rhabdomyolysis after proximal humerus fracture associated with axillary artery rupture

The anatomical proximity of axillary artery to the humeral head makes it quite vulnerable to blunt trauma during shoulder injury. Axillary artery rupture and prolonged ischemia may lead to rhabdomyolysis and acute renal failure. Herein we present a case of a patient who sustained proximal humerus fracture associated with axillary artery rupture and acute renal failure due to rhabdomyolysis.     

Neonatal renal failure due to obstructive candidal bezoars

Acute renal failure (ARF) developed in a 7-week-old infant due to bilateral candidal bezoars (fungal balls) causing obstruction at the pelviureteric junction. The baby was born at term with an appropriate birthweight, and had been treated with broad-spectrum antibiotics for respiratory distress and septicemia during the 1st week of life. Recovery from ARF followed renal decompression with bilateral nephrostomy tube placement and parenteral administration of amphotericin B and 5-flucytosine. Received August 21, 1996; received in revised form and accepted January 3, 1997     

Prognosis of acute renal failure in children: a multivariate analysis

Various factors were analyzed in 80 consecutive children under 16 years who had acute renal failure (ARF), for various prognostic factors. Overall mortality was 42.5%, with significantly higher levels seen in hemolytic uremic syndrome (68%, P <0.05) and associated with cardiac surgery (90.9%, P <0.01). Anuria (67.6% vs. 43.5%, P <0.05), need for dialysis (85.3% vs. 56.5%, P <0.05), neurological complications (50% vs. 6.3%, P <0.01), and respiratory complications (35.2% vs. 2.1%, P <0.01) were significantly higher in nonsurvivors than survivors. Multiple regression analysis showed the presence of neurological and respiratory complications to be poor prognostic factors. Received May 2, 1995; received in revised form August 28, 1996; accepted September 13, 1996     

Continuous arteriovenous hemofiltration in acute renal failure

This extensive review describes the settings for continuous arteriovenous hemofiltration (CAVH) and attempts to compare it to traditional dialysis therapies for acute renal failure. In addition hemodynamic stability, membrane biocompatibility, nutrition, fluid and solute removal, operational characteristics, anticoagulation, replacement solutions, drug removal, complications, and trouble shooting during CAVH are all discussed in detail. The cost of CAVH v dialysis is equal. CAVH is probably the renal replacement therapy of choice for hemodynamically unstable patients with acute renal failure and contraindications to peritoneal dialysis.     

Transient acute renal failure due to nitrofurantoin poisoning

A 3-year-old girl developed acute oliguric renal failure after accidental ingestion of nitrofurantoin (190 mg/kg body weight). The time interval between poisoning and the onset of renal failure was 9 days. She later recovered with symptomatic management. Received: 4 September 1998 / Revised: 11 February 1999 / Accepted: 15 February 1999     

狼疮肾炎急性肾功能衰竭30例临床与病理分析

目的 为了探讨狼疮性肾炎并急性肾衰的治疗措施、改善其预后。方法 收集1991年～1955年符合狼疮肾炎合并急肾衰者共30例进行分析研究。结果 在血液透析或腹膜透析的基础上,大剂量甲基强的松龙及环磷酰胺联合冲击治疗,总有效率为56.7％,死亡率为33.3％、结论 与预后相关因素有大量蛋白尿、血清补体下降显著、Ccr降低、血和尿FDP升高、双肾肿大或萎缩、累及脏器的多少等,这些均可作为临床评估预后和指导治疗的参考。早期透析、大剂量甲基强的松龙和环磷酰胺冲击治疗、抗凝以及配合改善微循环药物、必要时配合血浆置换、重视治疗激发活动的应激因素,综合治疗措施可改善本病的预后。     

Acute renal failure associated with Yersinia pseudotuberculosis infection in children

We report 45 pediatric cases of Yersinia pseudotuberculosis infection confirmed by stool culture between May 1993 and June 1994. In 41 (91.1%) cases there had been contact with untreated well or mountain water. Y. pseudotuberculosis was also isolated from 4 samples of mountain spring water thought to be the sources of infection. During the course of the illness, acute renal failure (ARF) developed in 6 patients (13.6%). The age distribution of the ARF group (12.3±1.2 years) was significantly different from the non-ARF group (8.0±3.2 years). The serogroups of Y. pseudotuberculosis isolates from stool samples were 5 (n = 30) and 4 (n = 15). Isolates from the water samples were all serogroup 5. The main symptoms of both groups were fever, rash, abdominal pain, and vomiting. ARF developed between the 2nd and 14th days (mean 6 days) after the onset of fever, and oliguria (<400 ml/m² per day) developed in 3 patients (3/6, 50%) immediately after their fevers had subsided. ARF underwent a benign course, with complete recovery within a maximum of 4 weeks (mean 10.2 days), with 1 exceptional patient requiring hemodialysis. Renal biopsy showed evidence of tubulointerstitial nephritis. Y. pseudotuberculosis should be included as one of the causes of acute interstitial nephritis causing ARF in children, especially when the children have histories of drinking untreated water in endemic areas. Received August 24, 1995; received in revised form and accepted January 18, 1996     

Rhabdomyolysis and acute renal failure in a child with para-influenza type 1 infection

We present a rare case of para-influenza type 1 virus-induced rhabdomyolysis, complicated by acute renal failure (ARF). The child underwent continuous venovenous haemofiltration and has shown full clinical and biochemical recovery. ARF due to rhabdomyolysis in para-influenza type 1 infection in a child has, to the best of our knowledge, not been previously reported.     

Severity of illness scores and the outcome of acute tubular necrosis

The outcome of patients with acute renal failure (ARF)due to acute tubular necrosis (ATN) was evaluated inthis study. Two hundred and twenty-two patients witha mean age of 55.l ± 17.7 years (range 19–97years; male 153, female 69) who developed ATN in theperiod from July 1991 through January 1997 werestudied. Patients were divided into four groupsaccording to their APACHE II scores at the time of thediagnosis of ATN. Group I included patients with anAPACHE II score of 14 or less (n = 70), Group II with ascore of 15–18 (n = 52), Group III with a score of 19–23(n = 58), and group IV with a score of 24 or above(n = 42). The mean APACHE II score for each of the fourstudy groups was 11 ± 0.4, 16 ± 0.2, 20 ±0.2, and 29 ± 0.7, respectively. Patient survivalwas evaluated by the Kaplan-Meier analysis withcensorship at 12 months. Survival rates at 180 dayswere 67%, 47%, 39%, and zero%, for group I through IV respectively, χ² = 27.99, p < 0.0001,with a median survival of >365, 120, 31, and 11days, for groups I through IV, respectively. For patients with oliguria (n = 88) survival at 180days was 23% vs. 58% for patients without oliguria(n = 134), p < 0.0001, median survival 13 vs. 364 d.Six months survival of those who required dialysis(n = 79) was 25% vs. 58% for those whom dialysis wasnot needed (n = 143), p = 0.001, median survival 15 vs.364 d, respectively. In patients with sepsis (n = 58),6 months survival was 35% vs. 50% for those withoutsepsis (n = 164), p = 0.013, median survival 14 vs. 169 d. In patients who required mechanical ventilation(n = 72), 6 months survival was 17% vs. 62% for those whodid not need respiratory support (n = 150), p = 0.0001,median survival 13 vs. > 365 d, respectively. Finally, 6 months survival in patients with one(kidney only), two, three, and four organ failure was76, 30, 11, and zero percent, respectively, p = 0.0001,median survival > 365, 16, 11, and 12 days,respectively. We conclude that the use of the APACHE II score forthe stratification of the severity of illness could beof clinical utility in predicting mortality inpatients with ATN. Other predictors of poor prognosisinclude the need for dialysis, the presence ofoliguria, the need for mechanical ventilation, thepresence of sepsis, and the number of failed organs. This revised version was published online in August 2006 with corrections to the Cover Date.