Assessment of Urinary Kidney Injury Molecule-1 in the Early Post-Burn Period to Predict Acute Kidney Injury for Various Degrees of Burn

Background: Acute kidney injury (AKI) is defined as a sudden and rapid decline in renal excretory function within hours to days, accompanied by an accumulation of nitrogenous waste products such as creatinine, urea, and other clinically unmeasured products. Historically acute kidney injury has carried a bad prognosis in the burn population.

Objective: To evaluate urinary kidney injury molecule-1 in the early post-burn period to predict acute kidney injury for various degrees of burn.

Methods: This prospective observational study was conducted in the Department of Nephrology, Dhaka Medical College Hospital, over one year from July 2016 to June 2017. 43 burn patients were enrolled in this study. Serum creatinine, BUN, and KIM-1 were measured on admission and within 48 hours of admission. SPSS 22.0 was used to analyze data. Kappa statistics were done, and AUC was calculated for KIM-1 to predict AKI.

Results In this study, most of the burn patients were below 35 years old. The mean age of the burn patients was 31.39±10.69 years. Males were predominant in burn patients. Maximum burns were due to flame (67.9%), and seven were from scald (13.2%). Mean TBSA was 30.62±14.89%. TBSA, serum creatinine, KIM-1 were significantly high in severe burn patients comparing mild and moderate burn patients. In this study, AKI was developed among 12 (27.9%) burn patients. TBSA was significantly high in AKI patients. Within 2 hours of admission, serum creatinine and BUN were normal in AKI and non-AKI patients, but the KIM-1 level was increased in AKI patients. By 48 hours of admission, urinary KIM-1, serum creatinine, and blood urea nitrogen were significantly higher in AKI patients comparing non-AKI patients.

Conclusion: Urinary KIM-1 is a valuable biomarker in predicting early AKI in burn patients. Our study suggests that urinary KIM-1 may be used as early, sensitive indicators of AKI in patients with burns of varying degrees and provide clinical clues for early AKI prevention.