The dialysis debate: acute renal failure in burns patients

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

“…[3] The incidence of ARF in our study was 22.5%, which is relatively higher than what is reported in other studies. [9,10] However, the incidence of ARF after thermal injuries appears variable according to what has been reported in the literature. [4] This could be explained by the fact that it depends on the severity of the burns and on the definition of ARF, which is different from one study to another.…”

“…[6] Furthermore, it has been shown that burn stress and its associated circulatory derangement stimulate the release of stress-related hormones, such as catecholamine, angiotensin II, aldosterone, and vasopressin. [6][7][8][9][10] These hormonal changes cause vasoconstriction and changes in regional blood flow, particularly in the kidneys. [11] On the other hand, the later appearance of acute renal failure is mainly associated with systemic sepsis, and is usually accompanied by other organ failure, such as pulmonary insufficiency, liver failure, or disseminated intravascular coagulopathy.…”

“…[15,17] This pattern of changes in the urinary MDA appears to be a very sensitive biochemical parameter and may be useful in the assessment of renal status. [8][9][10][11][12][13][14][15][16][17] Sepsis has been identified as a major factor contributing to mortality in burned children with acute renal failure. [23] Recently, it has become accepted that early fluid resuscitation and the prevention of sepsis may reduce the incidence of acute renal dysfunction in burned adult victims.…”

“…Elevated levels of stressrelated hormones also cause vasoconstriction, fluid retention, and renal hypoperfusion, with tubular necrosis leading to acute renal failure. [6][7][8][9][10][11][12] The administration of nephrotoxic antibiotics such as aminoglycosides and certain cephalosporins that are often used in treating burn infections is also a factor that may cause acute renal failure. [13] The vasodilator prostaglandin E2 is found in the kidneys and counteracts the effect of many vasoconstrictors.…”

“…These results are in agreement with what reported by Kang et al [17] This is also supported by data from animal and clinical studies demonstrating that burn shock manifests lesions in the renal tubules and glomeruli, with high and low-molecular weight proteins appearing in the urine. [6][7][8][9][10][11][12] It is known that burn injury initiates an appreciable oxidative stress and inflammation, leading to severe multiple organ failure. [7] Free radical production is associated with inflammation, and circulating lipid peroxides have been shown to increase in burn patients during the first week post-injury.…”