Burns and Acute Kidney Failure

Renal alterations such as proteinuria, hematuria, and electrolyte disturbances are common in patients with severe burns. Two distinct pictures with an early and a late form of acute kidney failure (ARF) have been described: The early form occurs in the immediate postburns period and can in most cases be effectively prevented by early aggressive fluid resuscitation. The late form develops after 2–3 weeks from initial injury and is usually due to sepsis and multiorgan dysfunction syndrome. In the last 20 years, onset and outcome of acute kidney failure in these patients has been improved by early aggressive burn wound excision, new powerful antibiotics, and early enteral nutrition for maintaining gastrointestinal trophism. In patients with established ARF, early intensive extracorporeal treatment is effective in reaching a mean survival rate of 20–50% of treated patients.