Continuous renal replacement therapy for rhabdomyolysis with acute kidney injury following multiple wasp stings_West China Medical Journal

Authors：

CHEN Dezheng ¹ , ZHANG Ling ² , LI Mingpeng ¹ , ZHANG Yong ¹ , FANG Hong ³ , XU Weijun ³ , WANG Mingli ¹ , YANG Jianbing ¹ , TANG Xiaoyan ¹ ,  FU Ping ²

1. Department of Nephrology, Jianyang People’s Hospital, Jianyang, Sichuan 641400, P. R. China;
2. Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Nephrology, Anyue People’s Hospital, Anyue, Sichuan 642350, P. R. China;

Corresponding author：

FU Ping, Email: fupinghx@163.com

Keywords：

Wasp stings; Rhabdomyolysis; Acute kidney injury; Continuous renal replacement therapy

DOI：

10.7507/1002-0179.201806117

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effect of continuous renal replacement therapy (CRRT) on rhabdomyolysis with acute kidney injury (AKI) following multiple wasp stings. Methods We designed a prospective study which enrolled 132 patients who developed rhabdomyolysis after multiple wasp stings between January 2013 and December 2016 in Jianyang People’s Hospital, West China Hospital of Sichuan University and Anyue People’s Hospital. Among these, 62 patients with AKI were treated with CRRT. The modality of CRRT was continuous veno-venous hemofiltration (CVVH). CVVH was performed for at least 48 hours by using Prismaflex and M100-AN69 hemofilter. Hemofiltration was accomplished using predilution bicarbonate with the replacement fluid rate of 2 000–2 500 mL/h [30–35 mL/(kg·h)]. Heparin or low-molecular-weight heparin was used for anticoagulation, with blood flow rate of 180–200 mL/min. Then intermittent hemodialysis was performed when patients’ condition became stable. Mortality, kidney recovery, biochemical indicators and length of stay were collected. Results Fifty-one patients met the inclusion criteria finally, and four (7.8%) of them died during hospitalization, and the remaining 47 patients survived with completed treatment and follow-up. At 3, 7, and 14 days after treatment, the creatine kinase, myoglobin and lactate dehydrogenase of the patients all decreased significantly and gradually, and returned to normal level finally. Kidney function was recovered in 45 (95.7%) patients within 3 months, and 2 patients suffered chronic kidney disease. The patients’ hemoglobin recovered to normal level at (30.5±11.3) days. Conclusion Rhabdomyolysis and AKI were severe complications following multiple wasp stings, and early CRRT may bring significant benefits to such patients.

Citation： CHEN Dezheng, ZHANG Ling, LI Mingpeng, ZHANG Yong, FANG Hong, XU Weijun, WANG Mingli, YANG Jianbing, TANG Xiaoyan, FU Ping. Continuous renal replacement therapy for rhabdomyolysis with acute kidney injury following multiple wasp stings. West China Medical Journal, 2018, 33(7): 848-851. doi: 10.7507/1002-0179.201806117 Copy

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2.	Kim YO, Yoon SA, Kim KJ, et al. Severe rhabdomyolysis and acute renal failure due to multiple wasp stings. Nephrol Dial Transplant, 2003, 18(6): 1235.
3.	Zhang R, Meleg-Smith S, Batuman V. Acute tubulointerstitial nephritis after wasp stings. Am J Kidney Dis, 2001, 38(6): e33.
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6.	Zhang L, Kang Y, Fu P, et al. Myoglobin clearance by continuous venous-venous haemofiltration in rhabdomyolysis with acute kidney injury: a case series. Injury, 2012, 43(5): 619-623.
7.	Dongol Y, Shrestha RK, Aryal G, et al. Hymenoptera stings and the acute kidney injury. EMJ Neph, 2013, 1: 68-75.
8.	Lima RS, da Silva Junior GB, Liborio AB, et al. Acute kidney injury due to rhabdomyolysis. Saudi J Kidney Dis Transpl, 2008, 19: 721-729.
9.	Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: rhabdomyolysis -- an overview for clinicians. Crit Care, 2005, 9(2): 158-169.
10.	Parekh R, Care DA, Tainter CR. Rhabdomyolysis: advances in diagnosis and treatment. Emerg Med Pract, 2012, 14(3): 1-15; quiz 15.
11.	Scharman EJ, Troutman WG. Prevention of kidney injury following rhabdomyolysis: a systematic review. Ann Pharmacother, 2013, 47(1): 90-105.
12.	丁盛, 张渝华, 张近宝, 等. RIFLE标准对蜂蛰伤并发多器官功能障碍患者行连续性静脉-静脉血液滤过治疗时机选择的价值. 第二军医大学学报, 2011, 32(4): 417-421.
13.	Oh HJ, Shin DH, Lee MJ, et al. Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury. J Crit Care, 2012, 27(6): 743.e9-743.e18.
14.	Zarbock A, Kellum JA, Schmidt C et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial. JAMA, 2016, 315(20): 2190-2199.
15.	Gaudry S, Hajage D, Schortgen F, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med, 2016, 375(2): 122-133.
16.	Naka T, Jones D, Baldwin I, et al. Myoglobin clearance by super high-flux hemofiltration in a case of severe rhabdomyolysis: a case report. Crit Care, 2005, 9(2): R90-R95.

1. Temizoz O, Celik Y, Asil T, et al. Stroke due to bee sting. Neurologist, 2009, 15(1): 42-43.
2. Kim YO, Yoon SA, Kim KJ, et al. Severe rhabdomyolysis and acute renal failure due to multiple wasp stings. Nephrol Dial Transplant, 2003, 18(6): 1235.
3. Zhang R, Meleg-Smith S, Batuman V. Acute tubulointerstitial nephritis after wasp stings. Am J Kidney Dis, 2001, 38(6): e33.
4. Kidney Disease: Improving Global Outcomes (KDIGO) AcuteKidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl, 2012, 2(1): 1-138.
5. Moreno M, Giralt E. Three valuable peptides from bee and wasp venoms for therapeutic and biotechnological use: melittin, apamin and mastoparan. Toxins (Basel), 2015, 7(4): 1126-1150.
6. Zhang L, Kang Y, Fu P, et al. Myoglobin clearance by continuous venous-venous haemofiltration in rhabdomyolysis with acute kidney injury: a case series. Injury, 2012, 43(5): 619-623.
7. Dongol Y, Shrestha RK, Aryal G, et al. Hymenoptera stings and the acute kidney injury. EMJ Neph, 2013, 1: 68-75.
8. Lima RS, da Silva Junior GB, Liborio AB, et al. Acute kidney injury due to rhabdomyolysis. Saudi J Kidney Dis Transpl, 2008, 19: 721-729.
9. Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: rhabdomyolysis -- an overview for clinicians. Crit Care, 2005, 9(2): 158-169.
10. Parekh R, Care DA, Tainter CR. Rhabdomyolysis: advances in diagnosis and treatment. Emerg Med Pract, 2012, 14(3): 1-15; quiz 15.
11. Scharman EJ, Troutman WG. Prevention of kidney injury following rhabdomyolysis: a systematic review. Ann Pharmacother, 2013, 47(1): 90-105.
12. 丁盛, 张渝华, 张近宝, 等. RIFLE标准对蜂蛰伤并发多器官功能障碍患者行连续性静脉-静脉血液滤过治疗时机选择的价值. 第二军医大学学报, 2011, 32(4): 417-421.
13. Oh HJ, Shin DH, Lee MJ, et al. Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury. J Crit Care, 2012, 27(6): 743.e9-743.e18.
14. Zarbock A, Kellum JA, Schmidt C et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial. JAMA, 2016, 315(20): 2190-2199.
15. Gaudry S, Hajage D, Schortgen F, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med, 2016, 375(2): 122-133.
16. Naka T, Jones D, Baldwin I, et al. Myoglobin clearance by super high-flux hemofiltration in a case of severe rhabdomyolysis: a case report. Crit Care, 2005, 9(2): R90-R95.

West China Medical Journal

Continuous renal replacement therapy for rhabdomyolysis with acute kidney injury following multiple wasp stings

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