Anticoagulation therapy for renal insufficiency after burns

Area of Science:

• Biomedical research
• Renal physiology
• Burn trauma management

Background:

• Severe burns (35% total body surface area) significantly impact blood coagulation, fibrinolysis, and kidney function.
• Early renal dysfunction, including oliguria, is a critical complication in burn patients.
• Understanding the effects of anticoagulation therapy on burn-induced kidney injury is essential.

Purpose of the Study:

• To investigate the effects of anticoagulation therapy on coagulation, fibrinolysis, and kidney function in rabbits with severe burns.
• To evaluate the efficacy of heparin and antithrombin III (AT-III) in preventing acute renal insufficiency post-burn.
• To compare different therapeutic strategies, including fluid therapy, heparin, and AT-III, in managing burn-related kidney complications.

Main Methods:

• Induction of full-thickness skin loss burns (35% TBSA) in rabbits.
• Administration of different therapies: no therapy, intravenous infusion, heparin, antithrombin III, and combined AT-III plus heparin.
• Serial measurements of kidney function tests, blood coagulation, fibrinolysis, blood viscosity, and hematocrit at baseline, 8 hours, and 24 hours post-burn.

Main Results:

• Non-therapy group exhibited oliguria and kidney function disturbance within 8 hours.
• Intravenous infusion group maintained urine volume but showed early non-oliguric renal insufficiency.
• Heparin group largely prevented burn-induced changes, but FENa and CH2O increased at 24h due to depressed AT-III activity.
• AT-III groups (with or without heparin) showed improved creatinine clearance (Clcr), with the combined AT-III plus heparin group demonstrating slightly superior results.

Conclusions:

• Immediate appropriate fluid therapy is crucial for preventing acute renal insufficiency after burns.
• Administering antithrombin III concentrate, alone or with heparin, is highly effective in preventing acute renal insufficiency in severe burn patients.
• Combination therapy of AT-III and heparin offers slightly better renal protective effects than AT-III alone.