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

mol/l. After HRRT, the conditions of these 2 patients improved progressively. Repeated CT scanning indicated a significant amelioration of APE within 5 and 3 days, respectively, in parallel with the laboratory improvement and clinical course ( fig. 1 ). Functions of the lung, heart, liver and kidney had recovered completely at discharge. The 2 patients were followed up for 2 months without any sign of residual organ dysfunction. There have been few reports about APE following wasp stings in the past 40 years [1, 2] , and the pathogenesis of APE due to wasp stings remains unclear. HRRT (CVVH + PE + SLED) in the management of APE and AKI following wasp stings has never been described. The benefits of CVVH both on cardiogenic pulmonary edema and noncardiogenic pulmonary edema are well known [3, 4] . Besides, CVVH represents a novel approach to remove circulating macromolecules like myoglobin (17 kDa) generated from rhabdomyolysis where intermittent hemodialysis (IHD) is inadequate. Compared to intermittent hemodialysis, CVVH guarantees more accurate volume control and more stable homeostasis, which are important for improving the prognosis, both for the survival of kidney function and the decrease in mortality. PE has been found useful because it can directly reduce the Wasp stings have been associated with a wide variety of reactions from mild local anaphylaxis-like wheal formation to fatal systemic complications. However, acute pulmonary edema (APE) is seldom reported in wasp venom poisoning. Here, we present 3 critically ill patients who developed APE and acute kidney injury (AKI) after multiple wasp stings and the successful intervention of hybrid renal replacement treatment (HRRT) in 2 of them. We retrospectively analyzed 3 patients (F/M rato: 2: 1, 39–56 years old) with APE and AKI following multiple wasp stings between 2008 and 2009 in West China Hospital. One of them died unexpectedly 2 h after admission to our hospital. Autopsy showed acute pulmonary venous pleonemia, APE and massive necrosis of renal tubular epithelial cells as well as hepatic cells. HRRT, including plasmapheresis (PE), continuous venous-venous hemofiltration (CVVH) and sustained low-efficiency dialysis (SLED), was carried out for the other 2 patients. PE was performed on day 1 and day 2, respectively; CVVH was applied for at least 72 h until the conditions became stable, then was replaced with SLED. Blood purification was discontinued when patients developed polyuria (urine volume 1 2,500 ml/day) with the level of serum creatinine less than 265 Published online: August 4, 2010