Anticoagulation therapy for renal insufficiency after burns

The changes in blood coagulation, fibrinolysis and kidney function and the effect of anticoagulation therapy using herapin were investigated in rabbits with full thickness skin loss burns covering 35 per cent of the total body surface area. Determinations of various kidney function tests, blood coagulation and fibrinolysis tests, blood viscosity and haematocrit values were made before burning and after 8 and 24h. Thirty rabbits were divided into a non-therapy group, an intravenous infusion group, a heparin group, an antithrombin III group and an antithrombin III plus heparin group and the results were compared. Oliguria and a disturbance of kidney function were noted 8 h after the burn in the non-therapy group. In the intravenous infusion group urine volume was well maintained although the early stage of non-oliguric renal insufficiency was noted. The changes noted in the intravenous infusion group were prevented almost completely in the heparin group but FENa and CH2O were elevated at 24h probably because antithrombin III activity was markedly depressed. In the antithrombin III group and the antithrombin III plus heparin group, however, creatinine clearance (Clcr) was moderately elevated while FENa and CH2O remained unchanged as compared with the values before the burn. The antithrombin III plus heparin group showed slightly better results than the antithrombin III group in Ucr/Pcr ratio, Clcr and CH2O. The results of the present study indicate that it is extremely effective to initiate appropriate fluid therapy immediately after a burn and to administer antithrombin III concentrate in combination with or without heparin for the prevention of acute renal insufficiency in patients with a severe burn.