Relapsing nephrotic syndrome with acute renal failure following a unique episode of multiple bee stings: A case report

Abstract

The commonest renal involvement after bee stings is acute kidney injury due to rhabdomyolysis. Nephrotic syndrome combined with AKI is unusual complication of Hymenoptera stings. We diagnosed a minimal change disease and six-year follow up relapses.

Keywords: acute kidney injury; bee sting; minimal change disease; nephrotic syndrome; tubulo‐interstitial disease.

FIGURE 1

Light microscopy of kidney biopsy. Cortical zone showing three glomeruli with normal architecture, mild hypertrophy, and no evidence of proliferative, inflammatory, necrotising, or sclerotic lesions. The tubules reveal irregularities along the luminal epithelial border, severe flattening, distension, and intraluminal debris, consistent with signs of acute injury (arrows). There are scattered lymphocytic cells at interstitium (arrow heads). Brown tubular casts are not recognized (Periodic acid‐Schiff stain, original magnification ×100).

FIGURE 2

Electron microscopy of kidney biopsy. Segment of a glomerulus with four capillary loops showing podocytes with complete foot processes effacement, swollen cytoplasm and condensed cytoplasmic filaments over the underlying basement membrane (arrows), consistent with a minimal change type lesion. Electron‐dense deposits are not observed, and the glomerular basement membranes appear normal (uranyl acetate‐lead citrate, original magnification ×7,200).

FIGURE 3

Serum creatinine and daily proteinuria during the follow‐up. Serum creatinine (mg/dL) and daily proteinuria (g/day) oscillation during the first episode of nephrotic syndrome in 2017, and the four subsequent relapses over the next 5 years. Only during the initial and unique episode of bee attack did the patient need renal replacement therapy.