Bee stings can cause severe reactions and have caused many victims in the last
years. Allergic reactions can be triggered by a single sting and the greater the
number of stings, the worse the prognosis. The poisoning effects can be systemic
and can eventually cause death. The poison components are melitin, apamin,
peptide 401, phospholipase A2, hyaluronidase, histamine, dopamine, and
norepinephrine, with melitin being the main lethal component. Acute kidney
injury (AKI) can be observed in patients suffering from bee stings and this is
due to multiple factors, such as intravascular hemolysis, rhabdomyolysis,
hypotension and direct toxicity of the venom components to the renal tubules.
Arterial hypotension plays an important role in this type of AKI, leading to
ischemic renal lesion. The most commonly identified biopsy finding in these
cases is acute tubular necrosis, which can occur due to both, ischemic injury
and the nephrotoxicity of venom components. Hemolysis and rhabdomyolysis
reported in many cases in the literature, were demonstrated by elevated serum
levels of indirect bilirubin and creatine kinase. The severity of AKI seems to
be associated with the number of stings, since creatinine levels were higher, in
most cases, when there were more than 1,000 stings. The aim of this study is to
present an updated review of AKI associated with bee stings, including the
currently advised clinical approach.