Marzo Aprile 2023 - In depth review

Acute kidney injury in severely burned patient: prevention and treatment

Abstract

Acute Kidney Injury (AKI) is associated with a great increase in morbidity and mortality in severely burned patients and occurs as a complication in more than 25% of these cases. The onset of ARF may be early or late. Early AKI depends mainly on reduced cardiac output resulting from fluid loss, rhabdomyolysis, or hemolysis. Late AKI, instead, is usually a consequence of sepsis and is often associated with multiorgan failure (MOF).

The first sign of AKI is the contraction of diuresis despite adequate volemic filling, which is followed by elevation of serum urea and creatinine. Fluid therapy is the main treatment in the burned victim: in the first few hours after injury, it aims to avoid hypovolemic shock and the possible related MOF, while later it becomes the cornerstone of treatment, besides antibiotic therapy in the case of sepsis onset. Particular care must also be taken in the choice of administered drugs in order to avoid possible nephrotoxic damage in addition to burning injury. Hemodialytic renal replacement therapy is used both for water balance management in patients requiring massive fluid infusions and for blood purification purposes to control the metabolic state, acid-base balance, and electrolytes abnormality. Our team has been collaborating for over 25 years in the management of severely burned patients admitted to the Centro Grandi Ustionati at the Bufalini Hospital in Cesena.

Keywords: Acute Kidney Injury (AKI), burn, sepsis, Continuous Renal Replacement Therapy (CRRT)

Sorry, this entry is only available in Italian.

Introduzione

Il danno renale acuto (Acute Kidney Injury AKI) è un evento che si verifica in più del 25% dei pazienti grandi ustionati e si associa a un tasso di mortalità elevato, di circa il 35% [1].

Si può presentare immediatamente dopo l’ustione oppure più tardivamente a seguito dello shock settico, nel contesto di insufficienza multiorgano (MOF) [2].

Solo una piccola percentuale degli ustionati affetti da AKI necessita del trattamento sostitutivo emodialitico (3% secondo una metanalisi del 2010, 8% secondo uno Studio del 2021), ma tra questi pazienti la mortalità è molto più elevata (65%-80%) [1, 3].  

La terapia con fluidi, il riconoscimento e il trattamento precoce della sepsi sono fondamentali per prevenire il danno renale acuto secondario a ustione [4]. 

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