Autologous creatinine clearance in a case of necrotizing fasciitis and anuria

Michael T. Eadon, Jay L. Koyner

Research output: Contribution to journalArticle

Abstract

Necrotizing fasciitis can present with concomitant acute kidney injury. The etiology of acute kidney injury is often multifactorial; potential sources include volume depletion, abdominal compartment syndrome, rhabdomyolysis, and acute tubular necrosis (which may be related to hemodynamic instability, medications, or sepsis/infection). Kidney injury, defined via changes in serum creatinine, portends increased morbidity and mortality. Thus, it is crucial to accurately diagnose and assess the severity of kidney injury. We present the case of a patient with necrotizing fasciitis who endured 31 consecutive days of complete anuria. His serum creatinine decreased over this interval without the use of extracorporeal hemofiltration or dialysis. The explanation for this novel phenomenon lies in massive daily sero-sanguineous discharge and insensible losses with subsequent volume resuscitation. The patient's own convective clearance was substantial enough to maintain a modest creatinine clearance of 15 ml/min during sustained anuria. Our case emphasizes the importance of employing the creatinine, estimated glomerular filtration rate, and urine output portions of the Acute Kidney Injury Network (AKIN) or Risk Injury Failure Loss End stage (RIFLE) criteria in assessing the severity of kidney injury. It further reinforces the imperfection in using serum creatinine as a primary measure of glomerular filtration rate.

Original languageEnglish (US)
Pages (from-to)225-229
Number of pages5
JournalAmerican journal of nephrology
Volume35
Issue number3
DOIs
StatePublished - Mar 1 2012
Externally publishedYes

Keywords

  • Acute renal failure
  • Burn
  • Debridement
  • Fasciitis
  • Necrotizing soft tissue infection

ASJC Scopus subject areas

  • Nephrology

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