Numerous studies have confirmed that there is an increased incidence of atopy (infantile eczema, allergic rhinitis and asthma) both in patients with steroid-sensitive nephrotic syndrome and their first degree relatives, although the occurrence of overt atopic disease at the time of nephrosis is uncommon
6,7. Several authors have reported a role for allergy in the development and maintenance of this disease, especially during childhood
2. There appears to be a pathogenic relationship between respiratory and food allergy and proteinuria in some cases of nephrotic syndrome
8. Atopic individuals presenting with nephrotic syndrome, especially if the nephrosis is frequently relapsing, may have increased levels of serum IgE and interleukin-4 (IL-4). Hypersensitivity type I responses with increased IgE and IL-4 have long been known to be involved in atopic diseases
9,10.
In the literature there are reports on the occurrence of nephrotic syndrome after insect sting, particularly bee stings 1-11, but these are very rare case. Shishkin 8 presented a series of 52 patients with various morphological forms of glomerulonephritis and history of allergy; 71% of his patients had elevated serum concentrations of IgE. Most of these patients had minimal change nephrotic syndrome and in one case the nephrotic syndrome ensued after insect sting. Also, in this study it was reported that normal levels of IgE were more frequently associated with steroid-resistant nephrotic syndrome characterized by a progressive decline of renal functions and severe damage to the glomeruli.
In a study by Elming and Solling 12, it was suggested that there may be a nonspecifically increased urinary excretion of albumin following insect sting, but none of their patients had developed nephrotic syndrome during follow up period.
Cuoghi et al. 13, in a series of 180 children with nephrotic syndrome found that three children had relapses triggered by the insect sting and all of them went to remission with steroid treatment. Clinical severity of nephrotic syndrome following bee sting and response to steroid / cytotoxic treatment is variably different 14,15.
Nephrotic syndrome in the case presented here was caused by a bee sting and also her serum IgE level was found elevated. Thus, existence of association between development to be of nephrotic syndrome and hypersensitivity can be considered, because it is reported that minimal change nephrotic syndrome patients with atopy history have increased levels of serum IgE 2,9,10. Also in agreement with the relevant literatures, our case had a very favorable clinical course with prompt response to corticosteroid treatment. All this conditions reveal that minimal change nephrotic syndrome associated with allergy has a very favorable response to corticosteroid treatment.
Cases of insect sting, particularly bee stings, must be closely followed up because of the multiple problems, especially for immune-mediated complications such as nephrotic syndrome.
