Abstract
Necrotizing fasciitis can present with concomitant acute kidney injury. The etiology of acute kidney injury is often multifactorial; potential sources include volume depletion, abdominal compartment syndrome, rhabdomyolysis, and acute tubular necrosis (which may be related to hemodynamic instability, medications, or sepsis/infection). Kidney injury, defined via changes in serum creatinine, portends increased morbidity and mortality. Thus, it is crucial to accurately diagnose and assess the severity of kidney injury. We present the case of a patient with necrotizing fasciitis who endured 31 consecutive days of complete anuria. His serum creatinine decreased over this interval without the use of extracorporeal hemofiltration or dialysis. The explanation for this novel phenomenon lies in massive daily sero-sanguineous discharge and insensible losses with subsequent volume resuscitation. The patient's own convective clearance was substantial enough to maintain a modest creatinine clearance of 15 ml/min during sustained anuria. Our case emphasizes the importance of employing the creatinine, estimated glomerular filtration rate, and urine output portions of the Acute Kidney Injury Network (AKIN) or Risk Injury Failure Loss End stage ...Continue Reading
References
Oct 26, 1978·The New England Journal of Medicine·P LoiratA Chapman
Jul 1, 1992·The Journal of Burn Care & Rehabilitation·J L SosaJ S Hammond
Apr 1, 1988·Burns, Including Thermal Injury·M SchiavonA Chiarelli
Oct 1, 1985·Critical Care Medicine·W A KnausJ E Zimmerman
Nov 1, 1982·Archives of Internal Medicine·M PlanasL W Henderson
May 1, 1995·Annals of Surgery·C R McHenryM A Malangoni
Oct 8, 1999·The Journal of Antimicrobial Chemotherapy·M J Weinbren
Feb 20, 2003·Dermatology : International Journal for Clinical and Investigative Dermatology·Ulrich R HenggeKurt W Schmid
Oct 1, 1951·Annals of Surgery·B W HAYNESF R DENMAN
Mar 18, 2004·Scandinavian Journal of Clinical and Laboratory Investigation·A LarssonL O Hansson
Jul 9, 2004·Critical Care Medicine·Chin-Ho WongCheng-Ooi Low
Feb 23, 2005·Archives of Surgery·Daniel A AnayaEileen Bulger
Aug 18, 2005·JAMA : the Journal of the American Medical Association·Shigehiko UchinoUNKNOWN Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators
Feb 14, 2006·Critical Care : the Official Journal of the Critical Care Forum·Kirsten ColpaertJohan Decruyenaere
Dec 15, 2006·British Journal of Clinical Pharmacology·J M ConilS Saivin
Oct 31, 2007·International Journal of Clinical Pharmacology and Therapeutics·J M ConilS Saivin
Jan 10, 2008·Journal of Burn Care & Research : Official Publication of the American Burn Association·Kukka-Maaria Mustonen, Jyrki Vuola
Jan 3, 2009·Kidney International·Lesley A StevensAndrew S Levey
Feb 21, 2009·Journal of the American College of Surgeons·Babak SaraniC William Schwab
Oct 31, 2009·Burns : Journal of the International Society for Burn Injuries·Michael DoltonAndrew J McLachlan
May 13, 2010·Critical Care : the Official Journal of the Critical Care Forum·Etienne MacedoUNKNOWN Program to Improve Care in Acute Renal Disease Study
Oct 23, 2010·Burns : Journal of the International Society for Burn Injuries·Peter L StollwerckFrank Siemers
Jun 28, 2011·Burns : Journal of the International Society for Burn Injuries·Sarah E BacheCharlotte Gilhooly
Aug 4, 2011·Journal of Renal Care·Michael YapCraig Courville