Markers of Tubular and Glomerular Injury in Predicting Acute Renal Injury Outcome in Thermal Burn Patients: A Prospective Study

Abstract

Background/aim. Thermal injury elicits several systemic consequences. Acute renal failure (ARF) is a well-known complication of severe burn and is an important factor leading to an increase in mortality. We aimed to focus on early diagnosis of acute renal failure occurring in major burns and to determine the predictors for acute renal failure. Subjects and methods. Forty patients with moderate to severe thermal burn injury-second-to third-degree with >20% of total body surface area-constituted the material of our study. The following parameters were recorded: age, sex, cause of the burn injury, burn surface of second and third degrees expressed as total body surface area burned in %, and Apache II score. All patients were subjected to routine investigations, including serum creatinine, blood urea nitrogen, fractional excretion of sodium, urinary malondialdehyde and microalbuminuria, completed on days 0, 3, 7, 14 and 21. Results. Nine patients (22.5% of all cases) developed acute renal failure, and four patients required supportive dialysis. The group that developed ARF showed rising markers of glomerular damage with appearance of microalbuminuria on day 0 that was maximal (3-4 times its normal level) at day 14 and constant with elevated serum creatinine, as well as burn size in the third week that progressed to overt proteinuria in three cases. Urinary malondialdehyde was also elevated before developing acute renal failure about three times their normal values, gradually increasing on day 14, associated with rising microalbuminuria followed by its decrease after controlling of septicemia. Two cases (22.2%) in ARF group who developed septicemia and required dialysis died on the 32 nd and 36 th days post-burn. Burn size and occurrence of septicemia were the only predictors of acute renal failure using multiple regression analysis (SE B 0.003 and 0.104; p value of 0.001 and .0371, respectively). Conclusions. Acute renal failure, which complicates 22.5% of burn patients, was found to be related to the size and depth of burn. Microalbuminuria and urinary malondialdehyde are useful markers for prediction of renal outcome in such group of patients. In our study. burn size and septicemia proved to be the only clinical parameters that predict renal outcome.

The utility of microalbuminuria measurements in pediatric burn injuries in critical care

“…Microalbuminuria has been shown to rise within 30 minutes of inflammatory and traumatic stimuli [5,20,43,44]. It has been shown to correlate well with outcomes in a heterogeneous group of adult patients in critical care as well as being as predictive as a number of more complex critical care severity scoring systems in assessing organ dysfunction and mortality [16][17][18][19][20][21][22][23][24].…”

“…There is a limited body of work investigating microalbuminuria in children [3,4], microalbuminuria in burns [20][21][22][23][24], and no published studies investigating the prognostic potential of ACR in pediatric intensive care patients.…”

“…More importantly, microalbuminuria measurements have shown some predictive value in terms of requirements for organ support and survival in a heterogeneous group of critically unwell patients including those with burn injuries [16][17][18][19][20][21][22][23][24].…”

“…Multiorgan failure accounts for up to 80% of all intensive care unit (ICU) deaths and represents a significant burden on ICU resources [29]. Rises in microalbuminuria in the critical care setting have been shown to be good prognostic indicators of organ support and outcome [16][17][18][19][20][21][22][23][24].…”

Burns

“…22,33 In the past, the International Acute Dialysis Quality Initiative group standardized the definition of acute renal insufficiency by developing the RIFLE criteria. 22,33 The RIFLE criteria define three different grades of acute renal injury (risk, injury, and failure) based on glomerular filtration rate, urine output, and two clinical outcome parameters (loss and end-stage kidney disease). 22,33 In 2007, the Acute Kidney Injury Network (AKIN) developed a modified standard for diagnosis and classifying acute kidney injury (AKI).…”