Acute kidney failure due to burns

Posted by Specialist Doctor II Phan Phi Tuan - Department of General Surgery - Vinmec Phu Quoc International General Hospital

In severe burns, the kidneys are severely affected, which can cause acute kidney failure. Conversely, kidney dysfunction will make the burn worse.

Acute renal failure has many mechanisms
1.1 Prerenal failure Usually appears in the first days after the burn, the main cause is a decrease in circulating volume. In addition, this condition can also be caused by pain causing renal vasoconstriction, causing anemia, plasma leakage causing glomerular capillary blockage, complications of septic shock after burns causing hypotension ..... now, Renal function remains, but if not treated appropriately, it will progress to renal failure in the kidney.
1.2 Renal failure in the kidney Usually appears late from the 2nd week after the burn onwards, due to damage, necrosis of renal tubular cells, which is mainly caused by prolonged prerenal failure. death. In addition, it is also possible that the renal tubules are blocked by Hemoglobin, Myoglobin (due to necrosis of muscle mass). Another cause of electrical burns is that when electrical current is passed, blood vessels can constrict and damage the vessel wall. Using nephrotoxic drugs, especially antibiotics after burns, can damage the kidneys and cause renal failure in the kidneys.

Epidemiological factors: Acute kidney failure due to burns is common in patients:
Deep and extensive burns causing large muscle tissue damage or high voltage electrical burns Respiratory burns Severe burn shock, prolonged low arterial blood pressure Infection bacteremia, septic shock, multi-organ failure Urine contains Hemoglobin, Myoglobin Prolonged use of nephrotoxic drugs of burns, acute burn-related renal failure typically progresses through four stages.
Stage 1: Patient is tired, nausea, vomiting, shortness of breath, chest pain, urine less and less, anuria. Stage 2: Full-blown with severe symptoms and potentially fatal complications. This phase lasts 1-6 weeks, on average after 7-14 days the patient will have urine again. This stage often has oliguria, anuria, edema. Depending on the disease, anuria, oliguria appear very quickly, and there are symptoms of excess fluid such as pulmonary edema, congestive heart failure. Symptoms of uremia such as internal bleeding, pericarditis, brain disorders. The patient takes deep breaths, vasodilation, and low blood pressure. Stage 3: Peeing again, on average 5-7 days. Have urine back 200-300ml/24 hours, urine volume gradually increase 4-5 liters/24 hours. Risks: Dehydration due to frequent urination, still increased urea, blood potassium, electrolyte disturbances. Stage 4: Recovery, about 4 weeks on average. Subclinical
Increased plasma creatinine and urea levels Electrolyte disturbances: Hyperkalemia causes cardiac arrhythmias such as high T wave, short QT, ventricular extrasystoles, ventricular fibrillation, torsades de pointes. Metabolic acidosis decreased pH, HCO3, decreased alkaline reserve. Urinalysis: Protein, electrolytes, urea, creatinine, urinary osmotic pressure, look for Hemoglobin, Myoglobin.

Prevention: An important measure.
Prophylaxis and aggressive anti-shock, do not let systolic blood pressure <70mmHg persist. For children, avoid excess fluid that causes edema. Use heart medications (ouabain), high doses of vitamin C. Stabilization requires acid-base and electrolytes. Reasonable antibiotics, less toxic to the kidneys. Quickly remove burn necrosis, cover the burn wound.
Use diuretics: Lasix 20mg/tube, dose 4-6 ampoules then 15 minutes or 1 hour, 2 ampules (total dose 1g/day). If you start to have urine, it is necessary to maintain Lasix to have an average urine volume of 1.5 - 2 liters per day. Note that diuretics should only be used when systolic blood pressure is > 80 mmHg and adequate fluid and electrolyte replacement. However, when using, it is necessary to monitor to avoid electrolyte disturbances, especially blood potassium, and hearing loss, especially when used with aminoglycoside antibiotics. Using mannitol causes osmotic diuresis, completely eliminated by the kidneys, 15% mannitol solution is infused intravenously in 60-100 ml within 20-30 minutes. If after 1-2 hours, urine is still < 50ml, then stop using. Fluid resuscitation: Adequate fluid replacement to raise blood pressure, fluid loss through burns, fever, mechanical ventilation and urine loss, especially when diuretics are used. Adjustment of acid-base and electrolytes Nutrition: The goal is to maintain protein sources by maintaining biological balance as close to normal as possible. Strictly control salt and water supply. Local treatment of burns. At the central levels, extra-renal dialysis can be performed when needed. Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured to visit. and hospital treatment. To register for examination and treatment at Vinmec International General Hospital, you can contact Vinmec Health System nationwide, or register online HERE.
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