Schiavon M, Di Landro D, Baldo M, De Silvestro G, Chiarelli A
Istituto di Chirurgia Plastica, Università di Padova, Italy.
Burns Incl Therm Inj. 1988 Apr;14(2):107-12. doi: 10.1016/0305-4179(88)90213-6.
The incidence of acute renal failure (ARF) in severely burned patients ranges from 1.3 per cent to 38 per cent and this complication has always been associated with a high mortality rate, of between 73 and 100 per cent. At present the exact mechanisms responsible for the onset of this complication are not well known. In order to elucidate some of these mechanisms, 20 patients with severe burns were studied for 1 year in an attempt to assess the prevailing glomerular or tubular localization of renal damage; the organic or functional pattern of renal damage and the reliability and possible prognostic significance of some renal function indices. These included the fractional excretion of sodium (FeNa), the alpha-glucosidases, the leucine aminopeptidases (LAP) and the serum and urine beta 2-microglobulin. The incidence of ARF in the patients studied was 26 per cent and in all cases it was of polyuric type. We believe that renal damage very often remains undetected when the traditional testing methods are used and that only in some patients does it become severe enough to result in ARF. In contrast, some of the tests considered in our study are extremely useful and reveal an impairment of renal function long before it becomes clinically apparent.
严重烧伤患者急性肾衰竭（ARF）的发生率在1.3%至38%之间，且这种并发症一直与73%至100%的高死亡率相关。目前，导致这种并发症发生的确切机制尚不清楚。为了阐明其中一些机制，对20例严重烧伤患者进行了为期1年的研究，以试图评估肾脏损伤主要是肾小球性还是肾小管性；肾脏损伤的器质性或功能性模式以及一些肾功能指标的可靠性和可能的预后意义。这些指标包括钠排泄分数（FeNa）、α-葡萄糖苷酶、亮氨酸氨肽酶（LAP）以及血清和尿液β2-微球蛋白。研究患者中ARF的发生率为26%，所有病例均为多尿型。我们认为，当使用传统检测方法时，肾脏损伤常常未被发现，只有在一些患者中，损伤才会严重到导致ARF。相比之下，我们研究中考虑的一些检测非常有用，能在肾功能损害在临床上显现之前很久就揭示出来。
