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Abstract

We appreciated the comments from Vikrant and Parashar.1Vikrant S. Parashar A. Wasp venom–induced acute kidney injury: a serious health hazard.Kidney Int. 2017; 92: 1288Scopus (9) Google Scholar Because of space limitations, we did not ignore but only commented briefly about wasp, hornet, and yellow jacket venom–associated acute kidney injury (AKI) in our review.2Burdmann E.A. Jha V. Acute kidney injury due to tropical infectious diseases and animal venoms: a tale of 2 continents.Kidney Int. 2017; 91: 1033-1046Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar Indeed, accidents with insects from the family Vespidae (wasps, hornets, and yellow jackets) have been associated with AKI in Asia, but not in Latin America, where Africanized bees, from the family Apidae, are the main hymenoptera responsible for insect venom–induced AKI. Venoms from the two genera, Vespa and Apis, have different characteristics. Vespa venom lacks melittin, considered the main toxic component in bee venom, and has higher interspecies composition and toxicity variability. The main toxic constituents of Vespa venom are phospholipases, hyaluronidase, antigen 5, active amines (such as serotonin, histamine, tyramine, and catecholamine) and peptides, such as kinins and mastoparans. The Vespidae venom causes hemolysis, cytotoxicity (comprising rhabdomyolysis), increased vascular permeability, and organ failure, including AKI.3Dongol Y. Shrestha R.K. Aryal G. et al.Hymenoptera stings and the acute kidney injury.EMJ Nephrol. 2013; 1: 68-75Google Scholar The majority of cases of AKI associated with Vespa venom occurred after multiple stings in men from rural areas, and most of the information available comes from case reports or descriptions of relatively small retrospective case series, with mortality and chronic kidney disease development rates of 9.3% and 10.7%, respectively.4Zhang L. Yang Y. Tang Y. et al.P. Recovery from AKI following multiple wasp stings: a case series.Clin J Am Soc Nephrol. 2013; 8: 1850-1856Crossref PubMed Scopus (27) Google Scholar The largest series is from China, in which an AKI frequency of 21% was reported among 1091 hospitalized patients with wasp stings.5Xie C. Xu S. Ding F. et al.Clinical features of severe wasp sting patients with dominantly toxic reaction: analysis of 1091 cases.PLoS One. 2013; 8: e83164Crossref PubMed Scopus (67) Google Scholar The most frequently described renal histological injury in Vespa venom–associated AKI is acute tubular necrosis, but cases of acute interstitial nephritis and acute cortical necrosis have also been reported.6Kumar V. Nada R. Kumar S. et al.Acute kidney injury due to acute cortical necrosis following a single wasp sting.Ren Fail. 2013; 35: 170-172Crossref PubMed Scopus (17) Google Scholar Wasp venom–induced acute kidney injury: a serious health hazardKidney InternationalVol. 92Issue 5PreviewEnvironmental toxins (snake, bee, and wasp venoms) and tropical infectious diseases (malaria and leptospirosis) are important causes of acute kidney injury (AKI) that are peculiar to the countries of Asia and Latin America. Wasp venom–induced AKI is a potentially fatal complication that follows mass attacks. Although it has become a serious health problem in China, South Asia, and Southeast Asia, it is underestimated and underrecognized.1,2 Even in a recent review by Burdmann and Jha, it has received no consideration. Full-Text PDF Open Archive