ABSTRACT
Acute kidney injury (AKI), a common and severe complication following burn injuries, presents a significant challenge due to its broad clinical manifestations and diverse etiologies. AKI, previously known as acute renal failure, can present abruptly following burns or thermal injuries, causing detrimental health outcomes such as progressive kidney dysfunction, increased hospital length of stay, and requirement of renal replacement therapy (RRT). AKI affects the maintenance of homeostasis of fluid and electrolytes, elimination of metabolic wastes and byproducts, and acid-base balance. Aggressive nutritional support is particularly necessitated in burn patients to prevent protein-energy wasting and a negative nitrogen balance. Understanding the pathogenesis of AKI in burns and improving its prevention and early diagnosis are active areas of research in this field. Despite the potential benefits, the optimal timing and threshold for RRT initiation in burn patients with AKI remain unclear, warranting further studies. Ongoing investigations focus on refining RRT techniques, evaluating biomarkers for early detection of AKI, and exploring adjunctive therapies to enhance renal recovery. The aim of this study is to review the etiology, diagnostic tools, and interventions that improve outcomes associated with AKI in burn-related settings.
Acute kidney injury occurs in nearly one-quarter of people with severe burns and leads to increased mortality rates. Burn injuries can be associated with numerous complications, such as hypermetabolic response, hypovolemia, hypotension, and sepsis, and involves early burn- and late burn-related complications. Validated metrics for classifying the extent of burn injuries, such as the Abbreviated Burn Severity Index on admission, Sequential Organ Failure Assessment Score on admission, Modified Marshall Score, baseline blood urea nitrogen, and serum creatinine all serve to discriminate the risk of acute kidney injury. With no current consensus on predictive energy equations or ideal nutritional goals, optimal nutritional support in burn patients with acute kidney injury largely relies on the burn severity, individual presentation of malnourishment, and timely resuscitation. Although novel biomarkers such as plasma and urinary NGAL levels, KIM-1, and IL-18 are still being investigated as diagnostic tools for acute kidney injury in both the early and late burn periods, and artificial intelligence/machine learning may soon be incorporated as an efficacious assessment tool in the future. Renal replacement therapy is often indicated in the setting of acute kidney injury due to severe burns, especially if the metabolic and fluid disturbances due to acute kidney injury are not adequately managed with fluid resuscitation, diuretics, electrolyte repletion, and other supportive measures. However, with over a third of all burn-related acute kidney injury patients requiring some form of renal replacement therapy, elevated mortality rates remain a cause for concern.
