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Submitted: 07 Feb 2020
Accepted: 01 May 2020
ePublished: 14 May 2020
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J Renal Inj Prev. 2020;9(3): e27.
doi: 10.34172/jrip.2020.27
  Abstract View: 139
  PDF Download: 74

Case Report

Plasma exchange and hemodialysis for severe manifestations of multiple wasp stings in a child

Eka Laksmi Hidayati 1 ORCID logo, Maulana Rosyady 1 ORCID logo, Henny Adriani Puspitasari 1 ORCID logo, Meilania Saraswati 2 ORCID logo, Angela Grace 1 ORCID logo, Cahyani Gita Ambarsari 1 * ORCID logo

1 Department of Child Health, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
2 Department of Pathology Anatomy, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
*Corresponding author: Cahyani Gita Ambarsari, Email: cahyani.ambarsari@ui.ac.id, cahyanigita@gmail.com

Abstract

Wasp stings occur frequently in developing countries and often lead to fatal outcomes due to the effects of wasp venom. Hemolysis and rhabdomyolysis often complicate wasp stings and result in acute kidney injury (AKI). We report a case of multiple wasp stings leading to AKI and multiple organ dysfunction syndrome (MODS) in a 9-year-old Indonesian girl. Kidney biopsy revealed acute tubular necrosis and acute interstitial nephritis. Despite delayed admission, she recovered in 33 days after 3 days of intravenous steroid administration, eight sessions of intermittent hemodialysis, and two sessions of plasma exchange (PE). Complete recovery of kidney function, indicated by normal diuresis, normal estimated glomerular filtration rate, and negative albuminuria, was reached within 12 weeks. This case showed that immediate admission following multiple wasp stings (particularly >10 stings) to initiate early dialysis is important to promptly remove toxins and preserve kidney function. The case also showed that PE can be beneficial in cases of hemolysis and rhabdomyolysis complicated by MODS.
Keywords: Sting, Hemolysis, Multiple organ failure, Rhabdomyolysis, Plasma exchange, Wasp

Implication for health policy/practice/research/medical education:

All patients with multiple wasp stings should undergo complete laboratory examination. If specific organ involvements are identified, referral to centers with extracorporeal treatment modalities could be required.

Please cite this paper as: Hidayati EL, Rosyady M, Puspitasari HA, Saraswati M, Grace A, Ambarsari CG. Plasma exchange and hemodialysis for severe manifestations of multiple wasp stings in a child. J Renal Inj Prev. 2020; 9(3): e27. doi: 10.34172/jrip.2020. e27

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