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Anaphylaxis Wasp Sting AKI — ESENeph MCQ

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ModerateAcute Kidney InjuryAnaphylaxis Wasp Sting AKIESENeph

A 45-year-old man develops AKI after a wasp sting. He has anaphylaxis with hypotension (BP 70/40 mmHg) requiring adrenaline and IV fluids. His creatinine rises from 80 to 300 umol/L over 48 hours. What is the primary mechanism of AKI?

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Correct answer: D — Haemodynamic AKI from anaphylactic shock – severe hypotension causes renal hypoperfusion and acute tubular necrosis; additional mechanisms include rhabdomyolysis (from prolonged hypotension/muscle ischaemia) and rarely direct venom-induced intravascular haemolysis

Anaphylaxis-related AKI is primarily haemodynamic – severe hypotension causes renal hypoperfusion leading to ATN. Additional contributing mechanisms include: rhabdomyolysis (from prolonged hypotension, muscle ischaemia during cardiovascular collapse, and the intense muscular contraction from anaphylaxis), intravascular haemolysis (rare, from massive mast cell degranulation), and myoglobin/haemoglobin-induced tubular injury. In some cases, direct venom toxicity contributes (bee and wasp venom contain phospholipases and melittin that can damage renal tubular cells). Management is supportive: treat the anaphylaxis, aggressive fluids, and RRT if needed.

Reference: KDIGO 2012 – AKI; Resuscitation Council UK – Anaphylaxis