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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2014  |  Volume : 25  |  Issue : 2  |  Page : 423-424
Frequency and prognosis of acute kidney injury in burned patients


Department of Nephrology, Chronic Kidney Disease research center, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

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Date of Web Publication11-Mar-2014
 

How to cite this article:
Noshad H. Frequency and prognosis of acute kidney injury in burned patients. Saudi J Kidney Dis Transpl 2014;25:423-4

How to cite this URL:
Noshad H. Frequency and prognosis of acute kidney injury in burned patients. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2019 Apr 25];25:423-4. Available from: http://www.sjkdt.org/text.asp?2014/25/2/423/128608
To the Editor,

Acute kidney injury (AKI) is one of the most important complications in burned patients. [1] The management of burned patients improved in recent years and the mortality reduced, but AKI is seen more frequently. [2] There are so many classification methods for AKI severity, but the risk, injury, failure, loss, end-stage kid­ney disease (RIFLE) criteria are more frequently mentioned in the published literature. [3],[4] Prog­ression in burned patients management and recognition of exact pathophysiology of inflam­matory responses increased burn victims' sur­vival. According to various studies, the fre­quency of AKI is between 1% and 38% (it is dependent on the burn care center). [6],[7]

In a prospective cohort study at the Tabriz University of Medical Science, 100 burned pa­tients (61 male and 39 female) with a mean age of 45.2 ± 18.6 years admitted in the intensive care unit were studied (during 2008-2011). Patients with previous kidney problems (renal failure, glomerulonephritis, tubulointerstitial nephritis) or with initial serum creatinine grea­ter than 1.5 were excluded. Laboratory and clin­ical findings of AKI were seen in 76 patients, of whom only two patients (2.6%) had burned area <20% and 74 patients (97.4%) had burned area >20%. On the other hand, 18 (75%) patients without AKI had burned area <20% and six (25%) patients had >20% (P = 0.001).

In a multivariate analysis, it is shown that sep­sis, nephrotoxic drugs usage, hospital stay du­ration and burned area were the most important predicting factors of AKI and mortality. Morta­lity rate in patients with AKI was 38.2%, but it was 8.3% in patients without AKI (P = 0.004). In the group of AKI, 6.5% of the patients died if they were in the risk stage (P = 0.01), 30% if they were in the injury stage, 50% if they were in the failure stage and 100% if they were in loss stage. Nephrotoxic drugs was more com­monly used in patients with AKI (P = 0.01). Mechanical ventilation was used in 19.7% of patients with AKI (P = 0.08). Sepsis was seen more frequently in AKI patients (P <0.001). Type of burns (flame or liquids) has no signi­ficant difference in patients with and without AKI (P = 0.11).

AKI and severe oliguria is associated with a very high mortality rate and are seen more fre­quently during the resuscitation period; with appropriate therapy, they had no prognostic value. [8] That is why AKI has a broad spectrum of frequency rate in intensive care units (ICU) (between 15% and 40% and sometimes 13-38%). [8],[9]

Brusselares showed in his meta-analysis study that about 40% of patients present AKI and need for renal replacement therapy increases the mortality rate up to 80%. [10]

In our study, AKI was seen in about 76% of the patients admitted to the burn ICU. It is apparent that on-time adequate resuscitation with fluids and prevention of hypovolemia could reduce this rate. The most important risk factors were sepsis, burn area, hospital stay duration and nephrotoxic drugs. [6] Underlying medical problems such as diabetes mellitus, heart failure and other kidney problems are also very important. [4] Other risk factors that can impair renal function include hemodialysis, mechanical ventilation, sepsis, urgent operation and electrical injury. [3],[6],[10]

AKI is frequently seen in burned patients and is associated with a higher mortality rate. Con­trol of risk factors like sepsis, avoidance of nephrotoxic drugs, reduction of hospital stay time and on-time resuscitation of patients may reduce the mortality rate of burned patients. Finally, RIFLE criteria of AKI are a suitable method for classification of burned patients and can predict the outcome of these patients.

Conflict of interest: There is no conflict of interest.

 
   References Top

1.Hoste EA, Clennont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care 2006;10:R73.  Back to cited text no. 1
    
2.Chung KK, Juncos LA, Wolf SE, et al. Continuous renal replacement therapy improves sur­vival in severely burned military casualties with acute kidney injury. J Trauma 2008;64(2 Suppl):S 179-87.  Back to cited text no. 2
    
3.Ala-Kokko T, Ohtonen P, Laurila L, Martikainen M, Kaukoranta P. Development of renal failure during the initial 24 h of intensive care unit stay correlates with hospital mortality in trauma patients. Acta Anaesthesiol Scand 2006;50:828-32.  Back to cited text no. 3
    
4.Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: A multi­national, multicenter study. JAMA 2005;294: 813-8.  Back to cited text no. 4
    
5.Sabry A, Wafa I, El-Din AB, El-Hadidy AM, Hassan M. Early markers of renal injury in predicting outcome in thermal burn patients. Saudi J Kidney Dis Transpl 2009;20:632-6.  Back to cited text no. 5
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6.Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med 2007;35:1837-43.  Back to cited text no. 6
    
7.Bagshaw SM, George C, Bellomo R; ANZICS Database Management Committe. A compa­rison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008;23:1569-74.  Back to cited text no. 7
    
8.Mustonen KM, Vuola J. Acute renal failure in intensive care bum patients. J Burn Car Res 2008;29:227-37.  Back to cited text no. 8
    
9.Holm C, Horbrand F, von Donnersmarck GH, Miihlbauer W. Acute renal failure in severely burned patients. Burns 1999;25:171-8.  Back to cited text no. 9
    
10.Brusselaers N, Monstrey S, Colpaert K, Decruyenaere J, Blot SI, Hoste EA. Outcome of acute kidney injury in severe bums: A syste­matic review and meta-analysis. Intensive Care Med 2010;36:915-25.  Back to cited text no. 10
    

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Correspondence Address:
Hamid Noshad
Department of Nephrology, Chronic Kidney Disease research center, Sina Hospital, Tabriz University of Medical Sciences, Tabriz
Iran
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DOI: 10.4103/1319-2442.128608

PMID: 24626019

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