Acute kidney injury after burn

Audra Clark, Javier A. Neyra, Tarik Madni, Jonathan Imran, Herb Phelan, Brett Arnoldo, Steven Wolf

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

Acute kidney injury (AKI) is a common and morbid complication after severe burn, with an incidence and mortality as high as 30% and 80%, respectively. AKI is a broad clinical condition with many etiologies, which makes definition and diagnosis challenging. The most recent Kidney Disease: Improving Global Outcomes (KDIGO) consensus guidelines defined stage and severity of AKI based on changes of serum creatinine and urine output (UOP) across time. Burn-related kidney injury is typically classified as early (0–3 days after injury) or late (4–14 days after injury). Early burn AKI is typically due to hypovolemia, poor renal perfusion, direct cardiac suppression from TNF-alpha, and precipitation of denatured proteins, while late AKI is often due to sepsis, multi-organ failure, and nephrotoxic drugs. Diagnosis can be difficult as UOP and biochemical markers can be relatively normal even with significant renal injury. A sensitive and specific biomarker for the early diagnosis of AKI is sorely needed, and multiple potential biomarkers are being investigated. For treatment, the reversal of the underlying cause is the first intervention. The advent of renal replacement therapy has significantly improved the mortality of burn patients with AKI and should be initiated early if injury progresses despite initial maneuvers. Unfortunately, no beneficial pharmacologic agents have been identified, despite multiple investigations. Of burn patients who survive AKI, the vast majority do not receive long-term hemodialysis and they are generally thought to have a good renal prognosis although this view is shifting. Preliminary data in the burn population suggest that AKI may confer an increased risk of end-stage renal disease and long-term all-cause mortality, but further research is needed.

Original languageEnglish (US)
Pages (from-to)898-908
Number of pages11
JournalBurns
Volume43
Issue number5
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Fingerprint

Acute Kidney Injury
Wounds and Injuries
Kidney
Biomarkers
Mortality
Urine
Hypovolemia
Renal Replacement Therapy
Kidney Diseases
Burns
Chronic Kidney Failure
Renal Dialysis
Early Diagnosis
Creatinine
Sepsis
Tumor Necrosis Factor-alpha
Perfusion
Guidelines
Incidence
Serum

Keywords

  • Acute kidney injury
  • Acute renal failure
  • Burn
  • Thermal injury

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Clark, A., Neyra, J. A., Madni, T., Imran, J., Phelan, H., Arnoldo, B., & Wolf, S. (2017). Acute kidney injury after burn. Burns, 43(5), 898-908. https://doi.org/10.1016/j.burns.2017.01.023

Acute kidney injury after burn. / Clark, Audra; Neyra, Javier A.; Madni, Tarik; Imran, Jonathan; Phelan, Herb; Arnoldo, Brett; Wolf, Steven.

In: Burns, Vol. 43, No. 5, 01.08.2017, p. 898-908.

Research output: Contribution to journalReview article

Clark, A, Neyra, JA, Madni, T, Imran, J, Phelan, H, Arnoldo, B & Wolf, S 2017, 'Acute kidney injury after burn', Burns, vol. 43, no. 5, pp. 898-908. https://doi.org/10.1016/j.burns.2017.01.023
Clark A, Neyra JA, Madni T, Imran J, Phelan H, Arnoldo B et al. Acute kidney injury after burn. Burns. 2017 Aug 1;43(5):898-908. https://doi.org/10.1016/j.burns.2017.01.023
Clark, Audra ; Neyra, Javier A. ; Madni, Tarik ; Imran, Jonathan ; Phelan, Herb ; Arnoldo, Brett ; Wolf, Steven. / Acute kidney injury after burn. In: Burns. 2017 ; Vol. 43, No. 5. pp. 898-908.
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