---
title: "Nurse-led dynamic urine monitoring lowers AKI incidence after severe hymenoptera stings"
id: "pubmed-42687776"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42687776"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42687776/"
doi: "10.1093/joneph/aajag179"
published_at: "2026-09-03T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Nurse-led dynamic urine monitoring lowers AKI incidence after severe hymenoptera stings
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42687776
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42687776/)
- **DOI:** [10.1093/joneph/aajag179](https://doi.org/10.1093%2Fjoneph%2Faajag179)
- **Published At:** 2026-09-03T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This historically controlled retrospective study evaluated a **nurse-led dynamic urine monitoring** protocol for patients with severe hymenoptera stings using January 1, 2022 as the implementation cutoff. - Patients were divided into a historical control group (2019–2021) and a dynamic monitoring group (2022–2024). Propensity score matching was used to balance baseline covariates before outcome comparison. - The protocol incorporated objective urine color grading, high-frequency dynamic recording, and a standardized situation-background-assessment-recommendation escalation process led by nursing staff. - After matching, 260 patients were analyzed. The dynamic monitoring group had a lower overall incidence of **acute kidney injury (AKI)** (33.8% vs 52.3%, P = .003) compared with the historical control group. - Fewer patients in the dynamic monitoring group progressed to severe AKI (KDIGO stages 2–3; 27.7% vs 42.3%, P = .013). - The dynamic monitoring group achieved faster initiation of urine alkalinization, reached target fluid resuscitation volumes more quickly, and had a shorter emergency ICU length of stay (all P < .001). - Multivariate logistic regression found the nurse-led dynamic urine monitoring protocol independently associated with lower AKI risk (OR = 0.409, 95% CI: 0.232–0.720, P = .002). - The authors conclude that nurse-led dynamic urine monitoring enables earlier recognition and standardized response and is potentially effective for refined nursing care in this high-risk population. - The authors declared no conflicts of interest. Funding included a Zhejiang provincial Traditional Chinese Medicine science and technology program grant (2024ZL677).
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Nurse-led dynamic urine monitoring reduces acute kidney injury in patients with severe hymenoptera stings: a historically controlled retrospective study [Xuyuan Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+X&cauthor_id=42687776)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687776/#full-view-affiliation-1 "Department of Emergency Medicine, Hangzhou TCM Hospital of Zhejiang Chinese Medical University \(Hangzhou Hospital of Traditional Chinese Medicine\), Hangzhou, Zhejiang, China."), [Jiongbin Zheng](https://pubmed.ncbi.nlm.nih.gov/?term=Zheng+J&cauthor_id=42687776)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687776/#full-view-affiliation-1 "Department of Emergency Medicine, Hangzhou TCM Hospital of Zhejiang Chinese Medical University \(Hangzhou Hospital of Traditional Chinese Medicine\), Hangzhou, Zhejiang, China."), [Zhengmei Xue](https://pubmed.ncbi.nlm.nih.gov/?term=Xue+Z&cauthor_id=42687776)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687776/#full-view-affiliation-1 "Department of Emergency Medicine, Hangzhou TCM Hospital of Zhejiang Chinese Medical University \(Hangzhou Hospital of Traditional Chinese Medicine\), Hangzhou, Zhejiang, China."), [Gang Dong](https://pubmed.ncbi.nlm.nih.gov/?term=Dong+G&cauthor_id=42687776)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42687776/#full-view-affiliation-2 "Department of Orthopedics, Hangzhou TCM Hospital of Zhejiang Chinese Medical University \(Hangzhou Hospital of Traditional Chinese Medicine\), Hangzhou, Zhejiang, China.") Affiliations Expand ### Affiliations * 1 Department of Emergency Medicine, Hangzhou TCM Hospital of Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China. * 2 Department of Orthopedics, Hangzhou TCM Hospital of Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China. * PMID: **42687776** * DOI: [ 10.1093/joneph/aajag179 ](https://doi.org/10.1093/joneph/aajag179) Item in Clipboard # Nurse-led dynamic urine monitoring reduces acute kidney injury in patients with severe hymenoptera stings: a historically controlled retrospective study Xuyuan Xu et al. J Nephrol. 2026. Show details Display options Display options Format Abstract PubMed PMID J Nephrol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Nephrol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Nephrol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42687776/) . 2026 Sep 3:aajag179. doi: 10.1093/joneph/aajag179. Online ahead of print. ### Authors [Xuyuan Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+X&cauthor_id=42687776)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687776/#short-view-affiliation-1 "Department of Emergency Medicine, Hangzhou TCM Hospital of Zhejiang Chinese Medical University \(Hangzhou Hospital of Traditional Chinese Medicine\), Hangzhou, Zhejiang, China."), [Jiongbin Zheng](https://pubmed.ncbi.nlm.nih.gov/?term=Zheng+J&cauthor_id=42687776)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687776/#short-view-affiliation-1 "Department of Emergency Medicine, Hangzhou TCM Hospital of Zhejiang Chinese Medical University \(Hangzhou Hospital of Traditional Chinese Medicine\), Hangzhou, Zhejiang, China."), [Zhengmei Xue](https://pubmed.ncbi.nlm.nih.gov/?term=Xue+Z&cauthor_id=42687776)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687776/#short-view-affiliation-1 "Department of Emergency Medicine, Hangzhou TCM Hospital of Zhejiang Chinese Medical University \(Hangzhou Hospital of Traditional Chinese Medicine\), Hangzhou, Zhejiang, China."), [Gang Dong](https://pubmed.ncbi.nlm.nih.gov/?term=Dong+G&cauthor_id=42687776)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42687776/#short-view-affiliation-2 "Department of Orthopedics, Hangzhou TCM Hospital of Zhejiang Chinese Medical University \(Hangzhou Hospital of Traditional Chinese Medicine\), Hangzhou, Zhejiang, China.") ### Affiliations * 1 Department of Emergency Medicine, Hangzhou TCM Hospital of Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China. * 2 Department of Orthopedics, Hangzhou TCM Hospital of Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China. * PMID: **42687776** * DOI: [ 10.1093/joneph/aajag179 ](https://doi.org/10.1093/joneph/aajag179) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** To investigate the association of a nurse-led dynamic urine monitoring protocol with acute kidney injury (AKI) risk and clinical outcomes in patients with severe hymenoptera stings. **Methods:** A historically controlled retrospective design was adopted, with nurse-led dynamic urine monitoring protocol implementation date (January 1, 2022) as the cutoff. Patients were divided into historical control (2019-2021) and dynamic monitoring (2022-2024) groups. The protocol included objective urine color grading, high-frequency dynamic recording, and a standardized situation-background-assessment-recommendation escalation protocol. After propensity score matching was used to balance baseline covariates, AKI incidence and intervention timeliness were compared. Multivariate logistic regression was used to assess the independent association of nurse-led dynamic urine monitoring protocol with AKI risk. **Results:** Post-propensity score matching, 260 patients were included. Compared with the historical control group, the dynamic monitoring group had lower overall AKI incidence (33.8% vs. 52.3%, P = .003) and fewer patients progressing to severe AKI (Kidney Disease Improving Global Outcomes [KDIGO] stages 2-3; 27.7% vs. 42.3%, P = .013). Regarding response timeliness, the dynamic monitoring group showed shorter times to initiate urine alkalinization and achieve target fluid resuscitation volume, as well as a shorter length of stay in the emergency intensive care unit ([ICU]; all P < .001). Nurse-led dynamic urine monitoring protocol was independently associated with a lower AKI risk (odds ratio [OR] = 0.409, 95% confidence interval [CI]: 0.232-0.720, P = .002). **Conclusion:** Nurse-led dynamic urine monitoring protocol implementation is independently associated with reduced AKI incidence and shorter emergency ICU length of stay in patients with severe hymenoptera stings. By enabling early recognition and standardized response, nurse-led dynamic urine monitoring protocol is a potentially effective strategy for refined nursing care in this high-risk population. **Keywords:** acute kidney injury; dynamic urine monitoring; nurse-led care; severe hymenoptera stings. © The Author(s) 2026. Published by Oxford University Press on behalf of Societa Italiana Nefrologia/Italian Society of Nephrology; Society ownership. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. 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