Effective Management of Severe Burn Injury Complicated by Acute Kidney Injury in a Patient with Preexisting Chronic Kidney Disease.

Abstract

Acute kidney injury (AKI) is a common and severe complication in severe burns. Preexisting chronic kidney disease (CKD) can make the management more challenging. We present the management strategy adopted in such a case, highlighting the adaptations in fluid resuscitation, dialysis, and septicemia prevention. The case involved the 2^nd and 3^rd degree burns covering 53% body surface, in a patient with preexisting CKD and hypertension. Despite initial fluid resuscitation, the patient developed AKI. Sustained low-efficiency dialysis (SLED) was started, along with nutritional support using buttermilk diet. Aggressive antibiotic prophylaxis was initiated based on wound swabs culture and sensitivity. Wound debridement was deferred and daily dressing with silver nitrate gel and moisture-retaining film was used. Debridement and grafting were performed on postburn days 43 and 65. The patient was discharged after 80 days, with healed wounds. Our approach included meticulous fluid and nutrition supplementation coupled with SLED and appropriate wound management coupled with aggressive antimicrobial prophylaxis to prevent septicemia.