Markers of tubular and glomerular injury in predicting acute renal injury outcome in thermal burn patients: a prospective study.
OBJECTIVE
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.


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.
Nephrology Department, Mansoura Urology and Nephrology Center, Mansoura, Egypt. asabry2040@yahoo.com
Alaa
A
Sabry
Ahmed Bahaa
AB
El-Din
Al Moddather
AM
El-Hadidy
Mohammed
M
Hassan
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology; D015415:Biomarkers / Q000032:analysis*; D001806:Blood Urea Nitrogen; D002056:Burns / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D016009:Chi-Square Distribution; D002648:Child; D015331:Cohort Studies; D003404:Creatinine / Q000032:analysis; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007677:Kidney Function Tests; D007678:Kidney Glomerulus / Q000293:injuries; D007684:Kidney Tubules / Q000293:injuries; D008297:Male; D008315:Malondialdehyde / Q000032:analysis; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D006435:Renal Dialysis / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D055815:Young Adult
D015415:Biomarkers; D008315:Malondialdehyde; D003404:Creatinine