Hybrid Renal Replacement Treatment in Acute Pulmonary Edema with Acute Kidney Injury following Multiple Wasp Stings: A Report of 3 Cases

Zhang, Ling; Li, Zhengyan; Fu, Ping; Cao, Yu; Shi, Yunying; Liu, Fang; Su, Baihai; Xu, Huan

doi:10.1159/000319600

Cited by 6 publications

(4 citation statements)

References 4 publications

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“…Nonetheless, it is important to avoid over-hydration, as this may result in pulmonary and myocardial injury. Wasp venom and its metabolites can directly damage pulmonary capillary endothelial cells and alveolar epithelial cells, leading to pulmonary edema [ 18 ] that can be aggravated by infusion of large quantities of fluid [ 19 ]. Myocardial injury can cause excessive aldosterone and antidiuretic hormone secretion, elevating extracellular fluid volume and cardiac load, and thereby inducing heart failure [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of High-Volume Hemofiltration with Hemoperfusion Followed by Intermittent Hemodialysis in the Treatment of Acute Wasp Stings Complicated by Multiple Organ Dysfunction Syndrome

et al. 2015

PLoS ONE

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Multiple organ dysfunction syndrome (MODS) is a rare complication of wasp stings. Currently, there is no standardized treatment for MODS secondary to multiple wasp stings, although blood purification techniques are often used. This study aimed to analyze our experiences of using intermittent hemodialysis (IHD) with or without high-volume hemofiltration (HVHF) for treating acute wasp stings complicated by MODS. In this retrospective study, 36 patients with wasp stings complicated by MODS received either IHD combined with hemoperfusion, or HVHF (ultrafiltration flow rate, 70 mL/kg/h) combined with hemoperfusion for 5 days followed by IHD. Clinical symptoms, blood biochemical parameters, duration of mechanical ventilation, use of vasoactive agents, duration of hospital stay and survival rate were recorded, and Acute Physiology and Chronic Health Evaluation II (APACHE II) and multiple organ dysfunction (MOD) scores estimated. Patients treated with HVHF followed by IHD appeared to exhibit a faster recovery than those receiving IHD alone, as evidenced by superior improvements in MOD (4.29±1.08 vs. 2.27±1.07) and APACHE II (7.09±2.62 vs. 4.20±1.69) scores (P < 0.05). Patients treated with HVHF had significantly lower myoglobin, creatine kinase-MB, lactate dehydrogenase, bilirubin and creatinine levels than patients treated with IHD alone. In addition, the durations of hospital stay (13.15±2.77 vs. 27.92±3.18 days), vasopressor use (1.76±0.24 vs. 3.43 ± 1.01 days), mechanical ventilation (3.02±1.63 vs. 5.94 ± 2.11 days) and oliguria (6.57±2.45 vs. 15.29 ± 3.51 days) were reduced, and renal function more often recovered (85.1% vs. 53.1%), in the HVHF group compared with the IHD group (P < 0.05). These results raise the possibility that HVHF plus IHD may be superior to IHD alone for the treatment of acute wasp stings complicated by MODS; additional prospective studies are merited to explore this further.

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Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of High-Volume Hemofiltration with Hemoperfusion Followed by Intermittent Hemodialysis in the Treatment of Acute Wasp Stings Complicated by Multiple Organ Dysfunction Syndrome

et al. 2015

PLoS ONE

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“…The current study showed that the three treatment strategies (HD, CVVH/HD, and SLED/HD) could provide a similar mortality and recovery rates. A previous case report described the successful outcomes after using CVVH to treat MODS secondary to wasp attacks [12]; nevertheless, a meta-analysis study did not find the survival advantage of using CVVH over HD to treat MODS patients with acute renal failure [13]. Our study also suggested that the use of SLED, CVVH, or HD provided similar clinical outcomes when treating patients with wasp sting induced MODS.…”

Section: Discussionmentioning

confidence: 46%

Evaluation on treatment of sustained low-efficiency hemodialysis against patients with multiple organ dysfunction syndrome following wasp stings

Gou

Mao

et al. 2019

BMC Nephrol

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Background To evaluate the treatment of sustained low-efficiency hemodialysis (SLED) against patients with multiple organ dysfunction syndrome (MODS) following wasp stings. Methods Clinical data of 35 patients with MODS following wasp stings were retrospectively analysed. These patients were divided into three groups according to the treatment strategy used: 1) hemodialysis (HD) group, 2) continuous veno-venous hemofiltration (CVVH)/HD group, and 3) SLED/HD group. The clinical parameters, treatment outcome, and safety findings were compared among the three groups. Results The recovery rate (76.92% vs 77.78% vs 91.67%, p = 0.621) and mortality rate (15.38% vs 11.11% vs 8.33%, p = 0.999) were similar among the three groups. When compared to the HD group, patients treated with CVVH/HD or SLED/HD required a shorter period of time to enter into polyuria stage [(24.7 ± 4.3) days vs (20.2 ± 4.7) days vs (18.2 ± 3.0) days, F = 9.11, p = 0.0007], and required a shorter time for serum creatinine to return to normal [(45.7 ± 13.4) days vs (33.1 ± 9.4) days vs (31.9 ± 9.8), F = 5.83, p = 0.0069]; while such parameters had no significant differences between SLED/HD group and CVVH/HD group. The adverse events of hypotension and arrhythmia were found in the HD group, while no adverse events were reported in the SLED/HD and CVVH/HD groups. There was no significant difference in the cost of blood purification treatment between the SLED/HD group and HD group. Conclusion The use of SLED, CVVH and HD provided a comparable recovery and survival rates in patients with MODS secondary to wasp stings. Compared to HD, the use of SLED is recommended as a treatment strategy because of the efficacy on recover of renal function, satisfactory safety outcome, as well as the reasonable treatment cost.

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“…Notably, there was no data regarding the effect of blood purification on mortality or disease progression of venom-induced MODS. Most of the reports on the subject consist of case presentations in which PE and plasmapheresis combined with CVVHDF were used successfully [8,9] . The present study results not only indicated that both combinations of blood purification techniques played an important role in the management of venom-induced MODS, but also that PE + CVVHDF was the most effective blood purification therapy of the 2 combinations assessed.…”

Section: Discussionmentioning

confidence: 99%

“…However, many of these measures seem to lack therapeutic efficacy [7] . Two isolated case reports in the literature described the successful outcomes after using plasma exchange (PE) or plasmapheresis combined with continuous veno-venous hemodiafiltration (CVVHDF) to treat MODS secondary to wasp attacks [8,9] . Nevertheless, there is no specific and safe therapy currently available for the effective treatment of MODS resulting from mass wasp attacks.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Two Combinations of Blood Purification Techniques for the Treatment of Multiple Organ Failure Induced by Wasp Stings

Yuan¹,

Chen²,

Hu³

et al. 2016

Blood Purif

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Background/Aims: The aim of this study was to explore the clinical efficacy of 2 combinations of blood purification techniques in patients with sting venom-induced multiple organ dysfunction syndrome (MODS). Methods: A total of 23 patients received 35 sessions of hemoperfusion (HP) + continuous veno-venous hemodiafiltration (CVVHDF) treatment and 22 sessions of plasma exchange (PE) + CVVHDF treatment, respectively. Results: Both HP + CVVHDF and PE + CVVHDF reduced the levels of inflammation, thus improving our patients' health condition. Moreover, PE + CVVHDF was found to be significantly more effective in reducing the levels of specific liver function markers and inflammatory mediators, as well as shortening prothrombin time and increasing the levels of serum albumin. Conclusion: Both combinations of blood purification techniques were capable of improving MODS. However, the PE + CVVHDF approach was more efficient for the removal of wasp venom and inflammatory mediators from the blood.

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Hybrid Renal Replacement Treatment in Acute Pulmonary Edema with Acute Kidney Injury following Multiple Wasp Stings: A Report of 3 Cases

Cited by 6 publications

References 4 publications

Clinical Evaluation of High-Volume Hemofiltration with Hemoperfusion Followed by Intermittent Hemodialysis in the Treatment of Acute Wasp Stings Complicated by Multiple Organ Dysfunction Syndrome

Clinical Evaluation of High-Volume Hemofiltration with Hemoperfusion Followed by Intermittent Hemodialysis in the Treatment of Acute Wasp Stings Complicated by Multiple Organ Dysfunction Syndrome

Evaluation on treatment of sustained low-efficiency hemodialysis against patients with multiple organ dysfunction syndrome following wasp stings

Efficacy of Two Combinations of Blood Purification Techniques for the Treatment of Multiple Organ Failure Induced by Wasp Stings

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